Stress urinary incontinence in women: diagnosis and medical management

Stress urinary incontinence (SUI) is the most common form of urinary incontinence in women and is associated with high financial, social, and emotional costs. The history and physical examination can identify most patients with a significant stress incontinence component without the need for urodynamic testing. A variety of pharmacologic agents have been used off-label, but an evidence-based pharmacologic treatment has not been readily available. The development of a selective serotonin and norepinephrine reuptake inhibitor will add a potentially useful drug to the primary care physician's practice for treating female patients with SUI. In August 2004, a selective serotonin and norepinephrine reuptake inhibitor, duloxetine, became the first medication approved for the treatment of women with moderate to severe SUI throughout the European Union. As of November 2005, however, duloxetine has not been approved for the treatment of SUI in the United States.     

Stress incontinence in women; treatment by retropubic urethrovesical suspension

Twenty-four retropubic urethrovesical suspension operations were performed in a five-year period. Twenty-one of the patients were satisfied with the results, although the objective success of the operation did not always correlate with subjective relief of symptoms. The commonest apparent cause for failure was the coincidence of urgency with stress incontinence, and the few true failures, due to secondary relaxation of the paraurethral supports, were often mitigated by compensatory learning on the part of the patients, many of whom remain blissfully unaware of the underlying weakness. The retropubic urethrovesical suspension operation is simple, effective, and free of complications. It is indicated as a primary procedure whenever a vaginal operation has failed to cure (or, worse, has caused) stress incontinence. It is advised as a complementary procedure for women with a secondary complaint of stress incontinence who must undergo laparotomy for other cause.