Treatment options for intrinsic sphincter deficiency

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 cmH(2)O or a maximal urethral closure pressure <20 cmH(2)O, 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.

Magnetic resonance imaging in assessment of stress urinary incontinence in women: Parameters differentiating urethral hypermobility and intrinsic sphincter deficiency

“…Partial defects include laxity, fluttering or focal attenuation of ligaments. Complete disruption shows a discontinuity of ligamentous fibers [6,12] ; mostly affected and reproducibly visualized on imaging is PEL and pubourethral ligaments [10] . Findings are frequently accompanied by the abnormal vaginal configuration (loss of normal Hshape vaginal contour, or dropping vaginal fornix), best seen on axial images, and widening of the paravaginal attachments.…”

“…Also, Sand et al [5] studied women who failed retropubic suspension and found a higher failure rate in those with ISD. It has been shown that SUI caused by ISD is the most challenging to treat; with failure rates as high as 54% [6] . These failures were attributed to the correction of UH without concomitant increase of urethral closure pressures.…”

Retropubic tension-free vaginal tape and inside-out transobturator tape: a long-term randomized trial

“…Patients who were diagnosed with SUI with urethral hypermobility and in whom conservative treatments had failed were included. SUI patients with intrinsic sphincter deficiency, defined as a Valsalva leak-point pressure of <60 cm H 2 O, were excluded [16]. Other exclusion criteria were mixed urinary incontinence (MUI), pelvic organ prolapse (POP) greater than stage I (POP-Q system classification), and a past history of hysterectomy and pelvic reconstruction surgeries.…”

Diagnosis and Surgical Treatment of Stress Urinary Incontinence

“…A urethral closure pressure less than 20 cm of water or a leak point pressure less than 60 cm of water is commonly termed intrinsic sphincteric deficiency. [33][34][35][36] The presence of intrinsic sphincteric deficiency has meaning when treatment options are discussed. The size of the catheter can influence the result, because larger catheters will obstruct the urethra more than smaller ones.…”