The Diagnosis and Management of Urinary Incontinence in the Female

Abstract

Summary Ninety‐five patients complaining of urinary incontinence, 58 of whom had been subjected to previous unsuccessful surgery, were investigated by means of flow studies and voiding cine‐urethrocystography with simultaneous pressure recordings. Patients suffering from neurological lesions or fistulae were excluded from this study. It was found that urinary stress incontinence could result from weakness of the internal urethral sphincter, detrusor instability, urethral narrowing, or any combination of these three. Clinical symptoms and signs alone did not provide an accurate diagnosis. A rational plan of treatment, based on full investigation is outlined and attention is especially drawn to the treatment by internal urethrotomy ofincontinence due to urethral narrowing which may occur as a sequel to gynaecological surgery.

Pathophysiologic subdivision of genuine stress incontinence

“…The underlying cause is probably changes in the wall components. Such a condition has been described previously by several investigators [Moolgaoker et al, 1972;Susset et al, 1974, 19831. Susset et al [1983 termed this urethral rigidity and suggested the underlying cause to be urethra1 fibrosis.…”

Reduction in the incidence of stress incontinence complicating fistula repair

“…As long as the intravesical pressure does not exceed the pressure in the proximal urethra continence will be maintained (Erhorning, 1970). In a recent investigation of 95 cases, using cine-urethrocystography with simultaneous pressure recording, Moolgaoker et al (1972) found that urinary incontinence may result from weakness of the sphincter mechanism, detrusor instability, urethral narrowing or a combination of any of these factors. Incompetence of the urinary sphincter cannot be assessed before or during repair of the fistulae.…”

Female Urinary Incontinence

“…This leakage is essentially diurnal. Stress incontinence is not always unequivocal, and in 50% of cases a micturitional urge is mentioned with shortening of the security period after feeling a necessity to urinate, leading sometimes to false frequency which should be distinguished from uninhibited contractility [21].…”

“…It is the most frequent cause of urinary incontinence in older patients. Its frequency is assessed at 10% in the general population [20], and between 30 and 50% of women explored for urinary incontinence [21]. The precise pathogenesis of this functional bladder disorder is not always known.…”