The coexistence of intrinsic sphincter deficiency with type II stress incontinence

We investigate the coexistence of intrinsic sphincter deficiency and urethral hypermobility with type II stress incontinence and moderate cystocele.

Abdominal leak point pressure measurements were performed during cystometric evaluation with Valsalva's maneuvers in 50 consecutive women 33 to 73 years old (mean age 48.8) diagnosed with urethral hypermobility and moderate cystocele on pelvic examination and cotton swab test. Patients with unstable detrusor contractions or urgency with detrusor hypocompliance were excluded from the study.

Of the 50 women 36 (72%) had pure urethral hypermobility, and 14 (28%) were diagnosed with intrinsic sphincteric deficiency and hypermobility (mixed incontinence group), including 6 (42.8%) who had undergone previous surgery. No predisposing factor responsible for intrinsic sphincteric deficiency was noted in 8 mixed incontinence group patients (57.2%).

The high rate of intrinsic sphincteric deficiency in patients with urethral hypermobility indicates that the incidence with stress incontinence may be greater than previously believed, and may influence the apparently higher failure rates after bladder neck suspension. We believe that leak point pressure measurements are not necessary with sling procedures which correct urethral hypermobility and intrinsic sphincter deficiency but are required if bladder neck suspension is planned.