Stress Urinary Incontinence (SUI)

What is stress urinary incontinence?

SUI is the involuntary loss of urine during physical activities that put pressure on the bladder, such as cough, sneezing, laughing, or exercise. It occurs when the muscles and tissues supporting the bladder and urethra become weakened or damaged, leading to the loss of urine control.

What causes SUI?

In women, common factors include weakening of the pelvic floor muscles and tissues due to childbirth, pregnancy, hormonal changes (menopause), aging, obesity, or previous pelvic surgery. In men, the most common cause of SUI is following a prostatectomy for prostate cancer.

How is SUI diagnosed?

SUI is diagnosed through a medical history and physical exam. Additional tests may include a urine analysis to rule out other urinary tract issues, cystoscopy to evaluate the urethra and bladder, urodynamics testing to evaluate bladder function, and possibly imaging studies.

What are the treatment options for SUI?

Treatment options for SUI can vary depending on the severity of symptoms, and whether the patient is a male or female. Additionally, it is very common for patients with SUI to also have a component of urge urinary incontinence (the leakage of urine associated with urgency). In these cases, treatment is prioritized for the most bothersome component of the incontinence (stress or urgency).

Pelvic Floor Physical Therapy (PFPT)

The least invasive of treatment options is pelvic floor physical therapy. PFPT is a specialized form of physical therapy that focuses on the muscles, ligaments, and tissues in the pelvic floor region. There are almost no risks of undergoing PFPT, and it can be an effective option for both male and female patients with SUI.

Bulking agents

Urethral bulking agents are a minimally invasive surgical option for SUI. The agents is injected into the tissues surrounding the urethra to increase its resistance to urine leakage during moments of increased abdominal pressure. There are various bulking agents available such as synthetic substances, collagen-based materials or hydrogels. Bulking agents are typically more effective for female patients with mild to moderate SUI. The procedure is performed on an outpatient basis, and patients are typically able to resume their normal recoveries following the procedure. The duration of the effect varies, and some bulking agents may procedure benefits for several months to a few years. Repeat injections may be necessary to maintain the desired effect.

Slings

Slings are a surgical treatment option for SUI in both men and women. A sling, typically made of a synthetic mesh or tape, is inserted through a small incision in the vagina or lower abdomen. The sling is positioned beneath the urethra, and acts as a supportive hammock to improve the closure mechanism of the urethral. The success rates for slings are typically high, with most individuals experiencing a significant reduction or resolution of their SUI. The procedure is typically done in an outpatient setting, and patients will be advised to avoid heavy lifting or strenuous exercise for about a month after the procedure. Risks include difficulty with urination, urinary tract infections, urinary frequency or urgency, mesh erosion or extrusion, and injury to nearby structures.

Artifical urinary sphincter (AUS)

An AUS is a medical device used to treat severe SUI, particularly in men following prostatectomies. The AUS is designed to mimic the function of a natural sphincter muscle, which helps control the flow of urine. It consists of three components: a cuff that surround the urethra, a pump, and a pressure-regulating balloon. The cuff is placed around the urethra, the balloon is implanted in the scrotum, and the balloon is implanted in the groin. The cuff of the AUS is filled with fluid, which keeps the urethra closed, preventing urine leakage. When the person needs to urinate, they activate the pump, which temporarily deflates the cuff and allows urine to flow out. After urination, the cuff automatically re-inflates, closing the urethra to prevent leakage. Risks of the procedure include infection, erosion of the device, mechanical malfunction, urethral injury, pain, and difficulty with device activation.