[Stress urinary incontinence in women--current treatment alternatives].
BACKGROUND
Stress urinary incontinence in women occurs frequently. This paper gives a review of current treatment alternatives.


METHODS
The paper is based on the report from the 3 rd International Consultation on Incontinence, the Cochrane database, a PubMed search, and my own clinical experience as a urogynaecologist.


RESULTS
General practitioners may initiate conservative treatment without extensive evaluation. The first line treatment is pelvic floor muscle exercises (8-12 strong contractions X 3 every other day). Motivation and compliance are extremely important. Electrostimulation and treatment with vaginal cones are other options with comparable efficacy. Weight reduction (5-10%) may improve the condition significantly. Medical treatment with duloxetine tablets has recently become available. The efficacy of duloxetine is similar to that for pelvic floor exercise. Currently the most commonly used surgical procedures are midurethral retropubic or transobturatoric tension free vaginal tape, which are often done as day surgery and have lower morbidity than older procedures. Approximately 90% of the patients are satisfied with the results, and they continue to be so over time. Stress incontinence surgery is associated with complications such as de novo urge incontinence, impaired bladder emptying, recurrent urinary tract infections, pain and genital prolapse, but the risk is probably lower with tension free vaginal tape than with the older surgical methods.


CONCLUSIONS
Conservative treatment may reduce incontinence in many patients; it is simple, inexpensive and without risk of complications and is therefore the primary treatment option. Surgical treatment may cure the incontinence permanently, but there is a risk of permanent complications.
Schiøtz
Hjalmar A
HA
Kvinneklinikken, Sykehuset i Vestfold, 3103 Tønsberg. hjalmar.schiotz@siv.no
D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use; D000068736:Duloxetine Hydrochloride; D004599:Electric Stimulation Therapy; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D016496:Incontinence Pads; D017773:Pelvic Floor / Q000502:physiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013876:Thiophenes / Q000627:therapeutic use; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D014554:Urination / Q000502:physiology
D018759:Adrenergic Uptake Inhibitors; D000068736:Duloxetine Hydrochloride; D017367:Selective Serotonin Reuptake Inhibitors; D013876:Thiophenes