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.
About 25 percent of young women, 44 to 57 percent of middle-aged and postmenopausal women, and about 75 percent of older women experience urinary incontinence.
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.