Premium
THE PRINCIPLES GOVERNING THE TREATMENT OF STRESS INCONTINENCE OF URINE IN THE FEMALE 1
Author(s) -
Jeffcoate T. N. A.
Publication year - 1965
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1111/j.1464-410x.1965.tb09654.x
Subject(s) - stress incontinence , medicine , urethra , sphincter , urethral sphincter , urology , urinary incontinence , surgery
SUMMARY1 The female urethra is normally empty at all times except during voiding, and this means that continence is maintained by the internal sphincter at the urethro‐vesical junction. 2 The urethral resistance made up by muscle tone and elasticity of the urethra itself, and the external urethral sphincter, each offer secondary defence mechanisms which can sometimes prevent the escape of urine which leaks past an incompetent urethro‐vesical junction. 3 Continence does not ordinarily depend on the length of the urethra nor on its position in the pelvis. The incidence of stress incontinence is the same in women without as in those with prolapse. 4 Radiological studies of the urethra and the bladder base must include lateral views and care is needed over the technique to avoid the many possible artefacts and misinterpretations. The radiological sign of loss of the posterior urethro‐vesical angle, which indicates an incompetent internal sphincter, is seen in 90 per cent. of cases of stress incontinence. I n the remainder the radiographs usually show another cause and give a clear lead to treatment. 5 Stress incontinence is only rarely the result of trauma to the sphincter mechanism. Its leading cause is pregnancy and not labour, the conditions of pregnancy serving to reveal an intrinsic weakness in the tissues. 6 It is probably the high level of steroid hormones during pregnancy which lowers the tone of the internal sphincter. This explains why stress incontinence in the non‐pregnant woman is most troublesome during the premenstrual phase, and why this complaint can be induced by administering continuously large doses of estrogen and progestogens to previously continent women. 7 Operations such as bladder‐neck plication posteriorly or anteriorly, urethropexy, urethrocystopexy and urethral sling operations all cure by the same mechanism. They tighten the internal sphincter and restore the radiological anatomy of the urethro‐vesical junction to normal.