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Pathophysiology:
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.
Disease Statistics:
Two hundred thirty-nine (15%) of the 1589 Mexican-American women reported having urinary incontinence. Almost 33% reported urge incontinence symptoms, 10% reported stress incontinence symptoms, and 42% had symptoms suggestive of mixed incontinence.
Treatment:
Treatment is keyed to the type of incontinence. The usual approaches are as follows: Surgery, pelvic floor physiotherapy, anti-incontinence devices, and medication
Research:
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.