barinting.gif (538 bytes)

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.