Stress incontinence: alternatives to surgery.
Although surgery is commonly performed to alleviate or cure stress incontinence, there are non-surgical options that might well be explored and tried before a woman undergoes surgery, for which many are poor candidates. The least drastic treatments are behavioral therapies, chiefly pelvic floor muscle training (Kegel exercises), alone or with biofeedback. This method is effective but has the drawback of poor patient compliance. Another therapy, almost noninvasive, is electrical stimulation via needle or surface electrodes of the pudendal nerve and the pelvic plexus in order to treat detrusor instability. Some studies show good results for many patients; and there is no need for long-term compliance. Medical management has included hormone replacement therapy and alpha-adrenergic agonists, but questionable results and intolerable risks have shifted this mode to serotonin-norepinephrine reuptake inhibitors, which have CNS action. Finally, there are urethral occlusive devices, which have poor acceptance owing to side effects and difficulty of use, and vaginal pessaries, theoretically attractive but inexplicably poor performers in the marketplace.
Kielb
Stephanie J
SJ
Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA.
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001676:Biofeedback, Psychology; D004599:Electric Stimulation Therapy / Q000592:standards; D015914:Estrogen Replacement Therapy; D005081:Exercise Therapy / Q000592:standards; D005260:Female; D006801:Humans; D009119:Muscle Contraction; D017773:Pelvic Floor / Q000503:physiopathology; D010570:Pessaries / Q000592:standards; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D014481:United States; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D016387:Women's Health
D000316:Adrenergic alpha-Agonists; D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors