Continence and micturition involve a balance between urethral closure and detrusor muscle activity. Urethral pressure normally exceeds bladder pressure, resulting in urine remaining in the bladder. The proximal urethra and bladder are both within the pelvis. Intra-abdominal pressure increases (from coughing and sneezing) are transmitted to both urethra and bladder equally, leaving the pressure differential unchanged, resulting in continence.
Globally, up to 35% of the population over the age of 60 years is estimated to be incontinent. In 2014, urinary leakage affected between 30% and 40% of people over 65 years of age living in their own homes or apartments in the U.S. Twenty-four percent of older adults in the U.S. have moderate or severe urinary incontinence that should be treated medically.
Treatment is keyed to the type of incontinence. The usual approaches are as follows:
• Stress incontinence - Surgery, pelvic floor physiotherapy, anti-incontinence devices, and medication
• Urge incontinence - Changes in diet, behavioral modification, pelvic-floor exercises, and/or medications and new forms of surgical intervention • Mixed incontinence - Anticholinergic drugs and surgery
Currently, minimally invasive mid-urethral slings, such as the Tension-Free Vaginal Tape (TVT) Procedure, are the most common treatment option. TVT-SECUR is a newer, less invasive option that is performed through a single incision. It may offer some advantages to the traditional approach in that it is performed with fewer anesthesia’s and may be associated with less postoperative discomfort.