Abstract
Type III stress urinary incontinence (SUI) is generally defined as a condition that involves intrinsic sphincter deficiency (ISD). Although the clinical parameters for ISD are loosely defined as a Valsalva leak-point pressure <60 cmH2O or a maximal urethral closure pressure <20 cmH2O, consensus is lacking. As a result, studies evaluating the success of any treatment for ISD are difficult to interpret. Regardless, several studies over the past 20 years have evaluated a number of surgical and nonsurgical treatments specifically for SUI caused by ISD. Surgical options include retropubic suspension, needle suspensions, various types of suburethral slings and the artificial urinary sphincter, whereas nonsurgical options include urethral bulking agents. Assessing urethral function (specifically, leak-point pressure or maximal urethral closure pressure) and urethral hypermobility will enable treating physicians to determine the ideal solution for individual patients, especially as no standardized treatment for ISD exists.
Key Points
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Intrinsic sphincter deficiency (ISD) has classically been treated with pubovaginal slings
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However, the optimal treatment of ISD is not universally agreed upon
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Urethral bulking agents were developed for refractory stress urinary incontinence (SUI) caused by ISD
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Midurethral slings are widely used to treat SUI, including that caused by ISD
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The evolution of the midurethral sling (by the retropubic or transobturator methods) has further confused decision making for the treatment of ISD
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An assessment of urethral function (leak-point pressure or maximal urethral closure pressure) and of urethral hypermobility will help determine the ideal treatment
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S. M. Shah has received honoraria from American Medical Systems. G. S. Gaunay declares no competing interests.
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Shah, S., Gaunay, G. Treatment options for intrinsic sphincter deficiency. Nat Rev Urol 9, 638–651 (2012). https://doi.org/10.1038/nrurol.2012.177
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DOI: https://doi.org/10.1038/nrurol.2012.177
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