Department of Urology, First Affiliated Hospital of Harbin Medical University

Urinary incontinence is the involuntary leakage of urine through urethra, which causes inconvenience in life and even personal troubles. Types of urinary incontinence: (1) Functional urinary incontinence-urine oozing at any time, often accompanied by congenital abnormalities or postoperative complications. (2) Urgency urinary incontinence-typically it is too late to take off pants when going to the toilet, which is common when women suffer from cystitis. (3) Stress urinary incontinence-when abdominal pressure rises, urine will flow out involuntarily (especially when coughing, lifting heavy objects, laughing, going up and down stairs or sneezing). At this time, the bladder detrusor did not really contract. (4) Overflow urinary incontinence-when the bladder is stretched too high, it has lost its proper contraction function, so it overflows when it is filled. According to medical research, about 25% of women have urinary incontinence, and after delivery, as many as 60% of women face different degrees of urinary incontinence, and the severity can range from a few drops to completely uncontrollable. However, many people feel ashamed or shy. Until now, the problem of urinary incontinence has been isolated and hidden. The decrease of estrogen makes the urethral epithelial tissue thinner and the muscle tension near the bladder weakened. On the other hand, pregnancy and childbirth weaken the support of uterine muscle ligament, and the uterus and bladder droop. Therefore, coughing, laughing and urine leakage and incontinence during exercise have become embarrassing nightmares for women.

What shall we do? Get up the courage to go to the doctor. "Feeling embarrassed is the biggest obstacle to treating urinary incontinence." Urinary incontinence can be cured as long as the cause is found out and handled properly.

Female urinary incontinence can be divided into urge urinary incontinence and stress urinary incontinence. Urgency incontinence is characterized by a strong sense of urine, but before you reach the toilet, urine will involuntarily leak out, or when you hear the sound of running water, even if you drink a small amount of liquid, it will lead to involuntary leakage of urine. Stress urinary incontinence is characterized by involuntary urine leakage when walking, general physical labor or laughing or sneezing. Patients often go to the toilet several times in advance to avoid leaking urine. The cause of the disease is mainly caused by childbirth injury.

Stress urinary incontinence is a global disease and the most common female lower urinary tract disease at present. About 48% of adult women abroad suffer from urinary incontinence. At present, the incidence rate of female in China is about 29%, while 40% of adult women over 40 years old in Shanghai suffer from urinary incontinence to varying degrees. However, less than 10% patients went to the hospital, and only 0.7% people actually found a urologist.

Stress urinary incontinence refers to the involuntary outflow of urine caused by the increase of abdominal pressure, and its reasons are very complicated. At present, the main reasons found in the study are: older age, multiple birth history, obesity, long-term constipation, history of gynecological surgery, decreased estrogen level of postmenopausal women, long-term smoking and drinking. These factors can make the patient's urethral sphincter unable to control urine or weaken pelvic muscle strength, so that the patient's urethral pressure drops, leading to urine storage disorder. So can stress urinary incontinence be cured? With the appearance of new technology, the curative effect of stress urinary incontinence has been greatly improved.

Different types of urinary incontinence have different treatment methods, so the first and most important step of treatment is to determine what type of urinary incontinence it is, which often requires experienced specialists, combined with urinary incontinence manifestations and related examinations to determine. Treatment methods of urinary incontinence generally include behavioral therapy, drug therapy, assistive device therapy and surgical treatment.

With the continuous development of urology, TVT surgery, a minimally invasive method, is currently used. Only two 1 cm incisions are made in the patient's lower abdomen, and a synthetic sling is inserted from the vagina. The operation is simple, convenient, minimally invasive and quick to recover, and it is suitable for treating various types of stress urinary incontinence. Tension-free vaginal suspension (TVT) is a new minimally invasive surgical method for female stress urinary incontinence, which has developed rapidly abroad in recent years. Minimally invasive and effective, it is well received by patients.

In this technique, a special puncture needle is inserted through the small incision of the front wall of the patient's vagina, both sides of the urethra and retropubic space, and then passes through both ends of the epigastric wall of the pubic bone, so that the polypropylene mesh belt is suspended and fixed under the middle of the urethra in a U-shape, and then the abdominal pressure is increased after the patient's bladder is filled, so that the position of the sling can be adjusted under the tension-free state of the mesh belt to control urine overflow. The self-adhesion of the mesh belt can make it self-fixed without surgical suture. The surgically implanted reticular band can form a hammock-like structure with the surrounding proliferative tissues, replacing the relaxed and prolonged pelvic floor supporting structure and pubic urethral ligament, so that the patients with urinary incontinence can restore normal urethral closure function. After the operation, the patients' quality of life improved obviously.