Stress urinary incontinence (SUI)

Urinary incontinence associated with increased abdominal pressure or stress urine incontinence in women of any age occurs when an individual involuntarily loses urine after pressure is placed on the abdomen (i.e., during exercise, sexual activity, sneezing, coughing, laughing, or hugging), causing social and hygiene problems. That is why treatment and follow-up care of this type of patients is both medically and socially important.

In 1928, Dr. Howard Kelly, the first professor of gynecology at the Johns Hopkins Medical School, made the following statement regarding Urinary incontinence . "There is no more distressing lesion than urinary incontinence - a constant dribbling of the repulsive urine soaking the clothes which cling wet and cold to the thighs, making the patient offensive to herself and her family and ostracizing her from society." Stress incontinence is mainly characterized by a loss of urine caused by excessive mobility and the dropping of the bladder neck and the urethra (the tube between the bladder and opening of the vagina) due to pelvic floor disorders and/or intrinsic sphincter deficiency

Most commonly urinary incontinence is associated with a number of conditions, including pregnancy, extremely rapid or prolonged labour, gynecological invasions (procedures) (metrectomy, tumor removals etc.) obesity (in women), high impact physical activities, heart failure, lung problems, smoking, chronic cough, depression, constipation, and problems with mobility.

There are two types of treatment urinary incontinence: conservative and surgical.
Conservative treatment implies simple lifestyle or behavioral modifications including modifying the diet, reducing liquids before bedtime, or eliminating or adding medications, physical exercises to train pelvic muscles. Conservative treatment has been considered as the first line of treatment, although this approach is not always beneficial (favourable) (or does not always work well).

However it is surgery that offers the highest cure rate of treatment for any stress urinary incontinence. Nowadays there are more than 200 operative approaches to resolve this type of disorder. Most common and minimally invasive approaches are suburethral sling and the endoscopically controlled retropubic colposuspension (Burch procedure)

The choice of the operative technique depends on the degree of vaginal prolapse as well as any associated diseases, patient’s age, social and physical activities and existing symptoms of any functional straight intestine and gall bladder disorders.

Suburethral sling – is the most common and effective method of SUI (cases) permanent treatment. The procedure involves a narrow strip (sling) of synthetic material (TVT, TVT-O (Gynecare); SPARC, MONARC (AMS); Obtape (Mentor) positioning (placement) around the urethra to support its natural tissues, allowing to function as intended. Due to the synthetic sling exceptional strength and durability the risk of the SUI disorder recurrence is practically excluded and the side effects are minimal. Suburethral sling surgery takes 15- 20 minutes, has no age limitations, minimally invasive and can be performed under local anesthesia.

The patient is able to return home on the same or the following postoperative day.
Possible contraindications for the suburethral sling include vaginal front wall scarring deformities, urinary-tract and gall bladder inflammatory diseases, vaginitis, sexually transmitted diseases.

Follow-up visits are scheduled for three to four weeks after surgery. Patients may not lift heavy objects or engage in strenuous activity for approximately six weeks. Sexual intercourse may be resumed in one month following the surgery.