Urological management of stress urinary incontinence - our institutional experience

Background: Urinary incontinence (UI) is a common condition that affects approximately 27% (9-57%) of women worldwide. It has a negative impact on quality of life, especially in the domains of social, physiological, physical and sexual well‑being. The majority of the patients with UI have either stress or mixed incontinence. Stress urinary incontinence (SUI) has an observed prevalence of between 4% and 35%. Initial management of SUI includes behavioral therapy with or without pharmacotherapy. Then many types of surgery that have been performed to treat women with SUI. In this article we review our institutional experience on urological management of stress urinary incontinence, various procedures done and their outcomes.
Methods: This is a prospective analysis of case series of patients who presented with stress urinary incontinence to the Urology Department, in Government Kilpauk Medical College Hospital during the period of May 2017 to May 2018. Patients were thoroughly evaluated clinically & withall relevant investigations depending upon the individual clinical scenario. Patients were explained in their own language the nature of treatment and the principle behind it. Patients planned to treat SUI surgically were chosen carefully as indicated. Any complications of the procedure and patient acceptance were evaluated at each follow-up. The outcome of the treatment given were evaluated in the overall improvement in patient’s quality of life.
Results: In our study a total of 38 patients within the age range of 35 - 55 years with stress urinary incontinence were evaluated. All the patients included in this study were married with children. The distribution of parity noted were <2 in 6 (16%), >4 in 2 (5%) with the majority being with parity of 2-4 which is 30 (79%). In our study 37 patients were initially tried with behavioral therapy with pelvic floor exercises and dietary modifications. One patient with vault prolapse was planned for surgical correction by abdominosacro-colpopexy and proceeded. Patients who failed behavioral therapy were attempted pharmacological management. Patients who failed to respond to both behavioral and medical management, were selected for surgical correction after thoroughly evaluating. Behavioral therapy was opted in 37 patients with a success rate of 67.57%, medical management was given for 17 patients, including those who failed behavioral therapy. Of these 10 patients has significant improvement in symptoms with success rate of 58.82%. Seven patients who failed conservative measures and one patient with associated vault prolapse was treated with surgery with success rate of 100%. Of this, Transobturator sling procedure with prolene mesh (TOT) was proceeded in 4 patients, Stammey’s needle suspension was carried out in 3 patients and Abdomino sacrocolpopexy was done in one patient. In our study none of the patients had significant intraoperative/ postoperative complications. Postoperative results showed all patients were fully continent, with mild lower urinary tract symptoms reported in 2 patients. Incontinence was not reported in any of the patients postoperatively
Conclusion: Urological management of SUI involves multimodality therapy including behavioral, pharmacologic and surgical therapy. Treatment modality should be individualized to each patient taking into account various factors affecting urethral continence. Surgical therapy provides 100% success rate in terms of continence with minimal complications.