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It is estimated that 45.2%, 10.7%, 8.2%, and 21.5% of the 2008 worldwide population (4.3 billion) was affected by at least one lower urinary tract symptoms (LUTS), overactive bladder (OAB), urinary incontinence, and LUTS/bladder outlet obstruction (BOO), respectively (Irwin et al, 2011). Urinary incontinence is a major health issue and the total direct and indirect cost in the United States alone was estimated at $19.5 billion in 2000, of which 75% is for the management of women with this condition. Incontinence also results in psychological and medical morbidity, significantly impacting health-related quality of life in a manner similar to other chronic medical conditions including osteoporosis, chronic obstructive pulmonary disease, and stroke. Overall prevalence of female incontinence is reported at 38%, increasing with age from 20–30% during young adult life to almost 50% in the elderly (Anger et al, 2006; Hawkins et al, 2010). Recent advances in the understanding of pathophysiology, as well as development of novel pharmacotherapy and surgical techniques for stress, mixed, and urge incontinence (UI), have redefined contemporary care of this patient group.
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To facilitate comparisons of results and enable effective communication by investigators, the International Continence Society (ICS) has proposed standard terminology to be used to describe symptoms, signs, conditions, urodynamic findings, as well as treatment (Abrams et al, 2003). The ICS defines the symptom of urinary incontinence as “the complaint of any involuntary loss of urine.” It is also recommended, when describing incontinence, to specify relevant factors such as type, severity, precipitating factors, social impact, effect on hygiene and quality of life, measures used to contain the leakage, and whether or not the individual experiencing incontinence desires help.
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Incontinence can be transient or chronic. Transient incontinence may occur after childbirth or during an acute lower urinary tract infection and usually resolved spontaneously. Chronic incontinence can result from a multitude of causes and is often persistent and progressive. From a functional and anatomic perspective, it is intuitive to consider the lower urinary tract as a two-part system: the urinary bladder as a reservoir and the bladder outlet as a sphincteric mechanism. Incontinence occurs when either part or both malfunction. Several common types of incontinence are discussed herein: stress urinary incontinence (SUI), urgency urinary incontinence, mixed urinary incontinence (MUI), neuropathic incontinence, and overflow incontinence (OI).
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A step-wise management algorithm has been recommended for the management of male and female incontinence by the scientific committee of the 4th International Consultation on Incontinence (Abrams et al, 2010). In principle, the committee recommends an initial management and a specialized management algorithm for all types of incontinence. In initial assessment, one should identify the complicated incontinence group for specialized management. This includes recurrent or total incontinence, incontinence associated with pain, hematuria, recurrent infection, prostate irradiation, and radical pelvic surgery, suspected of fistula and significant postvoid residual. The following groups are suitable for initial management: stress incontinence, urgency incontinence, and incontinence with ...