Stress urinary incontinence
(SUI), is defined as an involuntary loss of urine during a sudden increase of intra
abdominal pressure, with no simultaneous detrusor contraction 1. .
Urinary continence results from a series of interlocking mechanisms .A combination of
acting factors exist, which includes the anatomical pelvic support, the urethral intrinsic
mechanism, the neuropsychological integrity and hormonal action.
The SUI diagnosis depends on the knowledge of pelvic anatomy and the complex mechanism of
urinary control. The choice of the adequate treatment must be taken in account the type of
urinary loss. The management must always be specified for each patient.
SUI classification is important, because it informs us of the type and degree of loss,
fundamental elements that indicate the treatment, be it clinical or surgical.
SUI may occur with or without anatomic alteration of the sphincterian mechanism. Stress
urinary incontinence of anatomic cause occurs when there is an inferior and posterior
displacement of the bladder neck and the proximal urethra to effort, with a consequence of
loss. In these cases abdominal leak point pressure is generally high.
On the other hand insufficiency or sphincterian incontinence is always a severe
incontinence and associated with intrinsic lesion of the urinary sphincter, it may or may
nor be associated to the falling of the bladder neck to effort. Despite the numeric value
being a point of controversy, McGuire shows that the losses with intravesical pressure
lower than 65 cm/H20, must be considered as sphincterian insufficiency 2
There may be concurrent of both psychopathological mechanisms in the same patient, and
that usually occurs 3 .
Urodynamic is usually the method of choise in the diagnosis of urinary loss and urinary
dysfunctions, specially the possibility of dispelling detrusor causes of loss.
Videourodynamics associates images of the inferior urinary tract during the analyses of
the pressure phenomenon and electromyographies.