Involuntary loss of urine which is
objectively demonstrable & is a social or
Stress incontinence: Involuntary expulsion of
urine under conditions of stress like rise of
intra-abdominal pressure due to coughing,
sneezing , laughing or lifting weights.
Upto 57% in women 45-64 yrs.
14% in general population.
Common condition, but rarely life
Adverse effect on quality of life
Embarrassment and anxiety.
Pathophysiology of stress
2. Detrusor pressure
excessively high i.
Causes of urinary incontinence
1. Genuine stress
weakness of bladder
neck, denervation of
of pelvic floor (during
2. Detrusor instability
3. Retention with overflow
4. Urogenital fistula
5. Temporary – UTI,
6. Urethral diverticulum
7. Congenital abnormalities- ectopic ureter,
bladder exstrophy etc.
8. Functional /neurologic disorders- dementia,
spinal lesions, space occupying lesions in
With full bladder in stress incontinence.
Local- excoriation of vulval skin.
Atrophic changes, cystocele, prolapse.
Bladder neck elevation test(Marchetti test)- To
see whether surgery will benefit or not.
Mental state, developmental anomalies,
chart or urinary diary.
iii. Pad test.
i. Uroflowmetry- 15-
differentiate betn GSI
pressure during filling ,
if > 15cm water after
250 ml DI
Residual urine- <5oml.
First sensation of urge
~250ml. If earlierurge
Bladder capacity- 500-
radiological screening of
bladder & urethra.
Most informative, but
Metallic bead chain
USG- position &
excursion of bladder
Management of GSI
a. Kegel’s exercises of pelvic floor muscles.
b. Wt. Reduction in obese patients.
c. Treat chronic cough, UTI.
d. Faradism- interrupted current to stimulate
muscles & nerves.
e. Drugs- Estrogen, α adrenergic agonists-
90% cure rate.
Elevate bladder neck & proximal urethra into
intra-abdominal position, support the bladder
a. Anterior colporrhaphy with Kelly suture.
b. Marshall-Marchetti-Krantz operation-
Surgical management (contd…)
c. Burch colposuspension.
d. Pereyra procedure.
e. Sling procedures- secondary- Stamey, Raz
f. Artificial sphincter implant.
g. GAX-collagen- periurethral injection.
h. Urinary diversion- Last.
Spontaneous or provoked detrusor
contractions during the filling phase when the
pt. Is attempting to inhibit micturition.
Urgency, urge incontinence, enuresis,
No specific clinical signs.