Urinary stress incontinence: differential diagnosis, pathophysiology, and management

It is appropriate to introduce this review of the subject of urinary stress incontinence with a discussion of other disorders that may produce abdnormal urinary leakage,at times even stimulating true anatomic stress incontinence. It is obviously important to correctly identify patients with these other conditions and not perform surgical procedures unlikely to relieve their symptoms. Thereafter, the underlying pathophysiology of stress incontinence is considered in detail, since its fundamental understanding serves as the basis for both accurate diagnosis and proper selection and effective execution of the operations designed to correct true anatomic stress incontinence. A final section on patient management covers choice of the optimal surgical procedure for each individual patient, end results that should be achievable by proper selection and performance of the various operations, and a descriotion of some of the technical details that seem particularly helpful in carrying out the three principal types of surgical procedres currently in use.