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    Both Urethra and Sphincter Can Be Involved in Stress Incontinence








    Stress incontinence is the most common type of urinary incontinence among women, causing loss of urine when sneezing, coughing, lifting, or otherwise putting pressure on the abdomen. Two conditions can cause this problem: the urinary sphincter, which controls flow of urine from the bladder, may be weak, or the urethra, which drains urine from the bladder, may be too loose (hypermobility).

    A new study suggests that one reason that surgery to correct problems with the urethra are often ineffective is that women with this problem may also have problems with the urinary sphincter, which haven't been identified.

    Researchers at the Ankara Hospital in Ankara, Turkey, evaluated 50 women, ages 33 to 73, who'd been diagnosed with urethral hypermobility and cystocele, a condition in which part of the bladder protrudes into the vagina. They looked to see if the women's incontinence was due only to urethral hypermobility or to a combination of that and sphincter problems.

    All of the women had abdominal leak point tests, in which the bladder is slowly filled using a catheter to see at what point leaking begins. This test identifies patients whose urinary sphincter is deficient.

    The researchers were surprised to find that 14 of the women (28 percent) had both conditions. Six of the 14 had undergone surgery that was ineffective in treating their incontinence.

    Writing in the "Journal of Urology," the authors noted that very little research has been done with women who have this mixed incontinence caused by both the sphincter and the urethra. Researchers and physicians have assumed that sphincter deficiency, which is the usual cause of incontinence in women, was not involved in cases of urethral hypermobility. But this study suggests that the two conditions occur together more often than was thought.

    The researchers point out that in patients with urethral hypermobility, if surgery to reposition the bladder neck is planned, urinary flow measurements should be done to determine whether the patient also has sphincter deficiencies that need to be corrected. If so, the surgery can be modified to stabilize the bladder neck and the urethra at the same time, making the procedure more likely to succeed.


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