GYN TRIAD
Stress Incontinence
Involuntary loss of urine
With coughing and sneezing
No urine lost at nightHistory. Loss of urine occurs in small spurts simultaneously with coughing or
sneezing. It does not take place when the patient is asleep.
Examination. Pelvic examination may reveal a cystocele. Neurologic
examination is normal. The Q-tip test is positive—when a lubricated cotton-
tip applicator is placed in the urethra and the patient increases intraabdominal
pressure, the Q-tip will rotate >30 degrees.
Investigative studies. Urinalysis and culture are normal. Cystometric studies
are normal with no involuntary detrusor contractions seen.
Management. Medical therapy includes Kegel exercises and estrogen
replacement in postmenopausal women. Surgical therapy aims to elevate the
urethral sphincter so that it is again an intraabdominal location (urethropexy).
This is done by attachment of the sphincter to the symphysis pubis, using the
Burch procedure as well as the Marshall-Marchetti-Krantz (MMK) procedure.
The success rate of both of these procedures is 85–90%. A minimally invasive
surgical procedure is the tension-free vaginal tape procedure in which a mesh
tape is placed transcutaneously around and under the mid urethra. It does not
elevate the urethra but forms a resistant platform against intra-abdominal
pressure.