Journal List > J Korean Med Assoc > v.48(4) > 1080512

Lee: Diagnosis and Treatment of Urinary Incontinence in Women


Urinary incontinence (UI) is a prevalent condition that can adversely affect a woman's quality of life. The prevalence of UI among Korean women was estimated up to 42% of the married female population. Overactive bladder syndrome (OAB) is a symptomatic diagnosis based on the presence of urgency, with or without urge incontinence, and usually accompanied by frequency and nocturia, in the absence of obvious pathologic or metabolic disease. Stress urinary incontinence (SUI), the complaint of involuntary loss of urine during effort or exertion or during sneezing or coughing, is the most common type of UI among women. Recommended initial evaluation methods of UI include validated symptom-questionnaire, 24 hour-voiding diary, 1-hour pad test, and provocative stress test. The initial management of OAB requires an integrated approach using behavioral and pharmacologic methods. Patients should be educated about the functioning of the lower urinary tract system, fluid and dietary management, timed or prophylactic voiding and bladder training regimens, and pelvic floor exercises (PFE). Although muscarinic receptor antagonists have been shown to be effective for the treatment of OAB, adverse effects, such as dry mouth, constipation, and blurred vision have limited their usefulness. Most cases of OAB are not cured, but the symptoms are reduced, with an associated improvement in the patients' quality of life. Patients who are not benefited by behavioral and pharmacologic intervention may respond to intravesical administration of drugs, including blockers of afferent input; intradetrusor injection of botulinum toxin, neuromodulation, and augmentation cystoplasty. The initial treatment of SUI includes behavioral changes and PFE. Bladder training, vaginal devices, and urethral inserts may also reduce stress incontinence. Surgical procedures are more likely to cure SUI than nonsurgical procedures. Based on a line of evidences available at this time, colposuspension (such as Burch) and pubovaginal sling (including the newer midurethral synthetic slings such as TVT) are the most effective surgical treatments.

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Detrusor myomectomy procedure
A) Careful division of the detrusor musculature using a knife blade, B) Sharp dissection of the musculature from the mucosa, C) Creation of anterior mucosal diverticulum
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DO: detrusor overactivity, UTI: urinary tract infection

*Number of patients with the complication divided by the total number of patients in all studies reporting that complication


6. Herzog AR, Fultz NH, Normolle DP, Brock BM, Diokno AC. Methods used to manage urinary incontinence by older adults in the community. J Amer Geriatr Soc. 1989. 37:339–344.
7. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Wein A, et al. The standardization of terminology of lower urinary tract function: Report from the standardization subcommitee of international continence society. Neurourol Urodyn. 2002. 21:167–178.
8. Stamey TA. Endoscopic suspension of the vesical neck for urinary incontinence in females. Report on 203 consecutive patients. Ann Surg. 1980. 192:465–471.
10. Ulmsten U, Petros P. Intravaginal slingplasty: An ambulatory surgical procedure for treatment of female urinary incontinence. Scand J Urol Nephrol. 1995. 29:75–82.
11. Blaivas JG, Groutz A. Walsh PC, Retik AB, Stamey TA, Vaughan ED, editors. Urinary incontinence: pathophysiology, evaluation, and management overview. Campbell's urology. 2002. 8th ed. Philadelphia: Saunders;1027–1052.
12. 1st International Consultation on Incontinence Recommendations of the International Scientific Committee: The evaluation and treatment of urinary incontinence. 1998. Incontinence;945–969.
15. Fantl JA, Wyman JF, McClish DK, Harkins SW, Elswick RK, Hadley EC, et al. Efficacy of bladder training in older women with urinary incontinence. JAMA. 1991. 265:609–613.
16. Fantl JA. Behavioral intervention for community-dwelling individuals with urinary incontinence. Urology. 1998. 51:2A Suppl. 30–34.
17. Jackson S. The patient with an overactive bladder? symptoms and quality-of-life issues. Urology. 1997. 50:6A Suppl. 18–22.
18. Andersson KE. 1997, 'The overactive bladder: pharmacologic basis of drug treatment'. Urology. 1997. 50:6A Suppl. 74–84.
19. Wein AJ. Pharmacologic options for the overactive bladder. Urology. 1998. 51:2A Suppl. 43–47.
20. Kelleher CJ, Cardozo LD, Khullar V, Salvatore S. 1997, 'A medium-term analysis of the subjective efficacy of treatment for women with detrusor instability and low bladder compliance'. British Journal of Obstetrics and Gynaecology. 1997. 104:988–993.
21. Drutz HP, Appell RA, Gleason D, Klimberg I, Radomski S. Clinical efficacy and safety of tolterodine compared to oxybutynin and placebo in patients with overactive bladder. International Urogynecology Journal and Pelvic Floor Dysfunction. 1999. 10:283–289.
22. Appell RA. Electrical stimulation for the treatment of urinary incontinence. Urology. 1998. 51:2A Suppl. 24–26.
23. Choi JH, Han DH, Cho J, Lee KS. Extracorporeal magnetic stimulation for the treatment of overactive bladder durability of efficacy. Korean J Urol. 2003. 44:Suppl 2. 160. Abst.
24. Wein AJ. Diagnosis and treatment of the overactive bladder. Urology. 2003. 62:20–27.
25. Macdiamind SA. Overactive bladder: Improving the efficacy of anticholinergics by dose escalation. Curr Urol Rep. 2003. 4:446–451.
26. Andersson KE, Yoshida M. Antimuscarinics and the overactive detrusor-which is the main mechanism of action? Eur Urol. 2003. 43:1–5.
27. Hohenfellner M, Dahms SE, Matzel K, Thuroff JW. Sacral neuromodulation for treatment of lower urinary tract dysfunction. BJU Int. 2000. 85:Suppl 3. 10–19.
28. Wein AJ. Walsh PC, Retik AB, Vaughan ED, editors. Neuromuscular dysfunction of the lower urinary tract and its management. Campbell's Urology. 2002. 8th ed. Philadelphia: WB Saunders Co.;931–1026.
29. Payne CK. Walsh PC, Retik AB, Vaughan ED, editors. Urinary incontinence: nonsurgical management. Campbell's Urology. 2002. 8th ed. Philadelphia: WB Saunders Co.;1069–1091.
30. Lee KS, Chung KJ, Kim JC, Joo MS. The effect of sacral neuromodulation in patients with the interstitial cystitis resistant to conservative treatment. Korean J Urol. 2003. 44:Suppl 2. 74. Abst.
31. Schurch B, Stohrer M, Kramer G, Schmid DM, Gaul G, Hauri D. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drug? Preliminary results. J Urol. 2000. 164:692–697.
32. Gross M, Boone TB, Appell RA. Surgical management of overactive bladder. Curr Urol Rep. 2002. 3:388–395.
33. Westney OL, Lee JT, McGuire EJ, Palmer JL, Cespedes RD, Amundsen CL. Long-term results of Ingelman-Sundberg denervation procedure for urge incontinence refractory to medical therapy. J Urol. 2002. 09. 168:1044–1047.
34. Chanceller MB. New frontiers in the treatment of overactive bladder and incontinence. Rev Urol. 2002. 4:S50–S56.
35. Atala A. Tissue engineering for the replacement of organ function in the genitourinary system. Am J Transplant. 2004. 4:Suppl 6. 58–73.
36. Cardozo L, Bachmann G, McClish D, Fonda D, Birgerson L. Meta-analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: second report of the Hormones and urogenital Therapy committee. Obstet Gynecol. 1998. 92:722–727.
37. Kegel A. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol. 1948. 56:238–248.
39. Bo K, Talseth T. Long-term effect of pelvic floor muscle exercise 5 years after cessation of organized training. Obstet Gynecol. 1996. 87:261–265.
40. O'Donnell PD, Doyle R. Biofeedback therapy technique for treatment of urinary incontinence. Urology. 1991. 37:432–436.
41. Kralj B. Ostergard DR, Bent AE, editors. The treatment of femalle urinary incontinence by functional electrical stimulation. Urogynecology and Urodynamics Theory and Practice. 1996. 4th ed. Baltmore: Williams & Wilkins;555.
42. Ericksen BC, Eik-Nes SH. Long-term electrostimulation of the pelvic floor: primary therapy in female urinary incontinence? Urol Int. 1989. 44:90–95.
45. Enzelsberger H, Helmer H, Schatten C. Comparison of Burch and lyodura sling procedures for repair of unsuccessful incontinence surgery. Obstet Gynecol. 1996. 88:251–256.
46. Lalos O, Berglund AL, Bjerle P. Urodynamics in women with stress incontinence before and after surgery. Eur J Obstet Gynecol Reprod Biol. 1993. 48:197–205.
47. Ulmsten U, Falconer C, Johnson P, Jomaa M, Lanner L, Olsson I, et al. A multicenter study of tension-free vaginal tape (TVT) for surgical treatment of stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 1998. 9:210–213.
48. Ulmsten U, Johnson P, Rezapour M. A three-year follow up of tension free vaginal tape for surgical treatment of female stress urinary incontinence. Br J Obstet Gynecol. 1999. 106:345–350.
49. Meschia M, Pifarotti P, Bernasconi F, Guercio E, Maffiolini M, Spreafico L, et al. Tension-free vaginal tape: analysis of outcomes and complications in 404 stress incontinent women. Int Urogynecol J. 2001. 12:Suppl 2. S24–S27.
50. Nilsson CG, Kuuva N, Falconer C, Rezapour M, Ulmsten U. Long-term results of the tension-free vaginal tape(TVT) procedure for surgical treatment of female stress urinary incontinence. Int Urogynecol J. 2001. 12:Suppl 2. S5–S8.
51. Rezapour M, Ulmsten U. Tension-free vaginal tape(TVT) in women with recurent stress urinary incontinence-A longterm follow-up. Int Urogynecol J. 2001a. 12:Suppl 2. S9–S11.
52. Rezapour M, Falconer C, Ulmsten U. Tension-free vaginal tape(TVT) in stress incontinent women with intrinsic sphincter deficiency(ISD)-A long-term follow-up. Int Urogynecol J Pelvic Floor Dysfunct. 2001. 12:Suppl 2. S12–S14.
53. Nilsson CGN, Rezapour M, Falconer C. 7 years follow-up of the tension-free vaginal tape procedure. Annual IUGA Meeting Abstract. 2003. 14:S35.
54. Ward KL, Hilton P. UK and Ireland TVT Trial Group. A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress urinary incontinence: Two-year follw-up. Am J Obstet Gynecol. 2004. 190:324–331.
55. Deval B, Levardon M, Samain E, Rafii A, Cortesse A, Amarenco G, et al. A French multicenter clinical trial of SPARC for stress urinary incontinence. Eur Urol. 2003. 44:254–258.
56. Balmforth J, Cardozo LD. Trends toward less invasive treatment of female stress urinary incontinence. Urology. 2003. 62:Suppl 4A. 52–60.
57. Boustead GB. The tension-free vaginal tape for treating female stress urinary incontinence. BJU Int. 2002. 89:687–693.
58. Hardart A, Klutke JJ, Klutke CG, Carlin B. Altered voiding after the tension-free vaginal tape procedure. Is increased resistance the mechanism of therapy. Obstet Gynecol. 2000. 95:Suppl 1. S35.
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