title: Severe adolescent female stress urinary incontinence (SAFSUI): case report and literature review.
abstract: BACKGROUND
  Severe adolescent female stress urinary incontinence (SAFSUI) can be defined as female adolescents between the ages of 12 and 17 years complaining of involuntary loss of urine multiple times each day during normal activities or sneezing or coughing rather than during sporting activities. An updated review of its likely prevalence, etiology, and management is required.
  
  
  METHODS
  The case of a 15-year-old female adolescent presenting with a 7-year history of SUI resistant to antimuscarinic medications and 18 months of intensive physiotherapy prompted this review. Issues of performing physical and urodynamic assessment at this young age were overcome in order to achieve the diagnosis of urodynamic stress incontinence (USI). Failed use of tampons was followed by the insertion of (retropubic) suburethral synthetic tape (SUST) under assisted local anesthetic into tissues deemed softer than the equivalent for an adult female.
  
  
  RESULTS
  Whereas occasional urinary incontinence can occur in between 6 % and 45 % nulliparous adolescents, the prevalence of non-neurogenic SAFSUI is uncertain but more likely rare. Risk factors for the occurrence of more severe AFSUI include obesity, athletic activities or high-impact training, and lung diseases such as cystic fibrosis (CF). This first reported use of a SUST in a patient with SAFSUI proved safe and completely curative. Artificial urinary sphincters, periurethral injectables and pubovaginal slings have been tried previously in equivalent patients.
  
  
  CONCLUSIONS
  SAFSUI is a relatively rare but physically and emotionally disabling presentation. Multiple conservative options may fail, necessitating surgical management; SUST can prove safe and effective.
authors.affiliation: St Vincent's Clinic, Suite 904, 438 Victoria Street, Darlinghurst, 2010, NSW, Australia, bernard@haylen.co.
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Haylen
authors.forename: Dianne
authors.initials: D
authors.lastname: Avery
authors.forename: Tin Lok
authors.initials: TL
authors.lastname: Chiu
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D052576:Menstrual Hygiene Products; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D026741:Physical Therapy Modalities; D012720:Severity of Illness Index; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000628:therapy*
chemical_list: D018727:Muscarinic Antagonists
references.citation: J Pediatr Urol. 2009 Dec;5(6):445-50
references.pmid: 19700371
references.citation: J Urol. 2001 Jun;165(6 Pt 2):2369-71; discussion 2371-2
references.pmid: 11398778
references.citation: Aust N Z J Obstet Gynaecol. 2008 Apr;48(2):214-7
references.pmid: 18366498
references.citation: J Urol. 1996 Feb;155(2):699-702
references.pmid: 8558708
references.citation: J Urol. 1992 Jul;148(1):127-30
references.pmid: 1613852
references.citation: Obstet Gynecol. 2008 Jun;111(6):1305-12
references.pmid: 18515513
references.citation: Am J Obstet Gynecol. 1954 Oct;68(4):1166-8
references.pmid: 13197481
references.citation: J Pediatr Urol. 2005 Apr;1(2):69-74
references.pmid: 18947539
references.citation: J Pediatr Surg. 1988 Mar;23(3):212-5
references.pmid: 3357135
references.citation: Int Braz J Urol. 2007 May-Jun;33(3):395-400; discussion 400-6
references.pmid: 17626658
references.citation: Urol Nurs. 2007 Feb;27(1):21-4, 39
references.pmid: 17390923
references.citation: J Urol. 2002 Sep;168(3):1150-3
references.pmid: 12187258
references.citation: Br J Urol. 1989 Jul;64(1):30-8
references.pmid: 2765766
references.citation: Int Urogynecol J Pelvic Floor Dysfunct. 2008 May;19(5):687-96
references.pmid: 18224267
references.citation: Int Urogynecol J. 2010 Jan;21(1):5-26
references.pmid: 19937315
references.citation: Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(2):134-137; discussion138
references.pmid: 11374512
references.citation: Br J Sports Med. 2009 Dec;43(14):1115-8
references.pmid: 18819959
references.citation: Int Urogynecol J Pelvic Floor Dysfunct. 1998;9(6):385-90
references.pmid: 9891960
references.citation: J Pediatr Urol. 2005 Feb;1(1):5-9
references.pmid: 18947528
references.citation: J Urol. 1969 Apr;101(4):545-9
references.pmid: 5776039
references.citation: J Epidemiol Community Health. 1993 Dec;47(6):497-9
references.pmid: 8120507
references.citation: Int Urogynecol J. 2011 Jan;22(1):3-15
references.pmid: 21140130
references.citation: Obstet Gynecol. 1994 Aug;84(2):183-7
references.pmid: 8041527
references.citation: J Urol. 2007 Feb;177(2):716-9
references.pmid: 17222665
references.citation: J Urol. 2012 Dec;188(6):2274-80
references.pmid: 23083648
references.citation: Int Urogynecol J Pelvic Floor Dysfunct. 2008 Mar;19(3):441-8
references.pmid: 18071619
references.citation: J Urol. 1994 Aug;152(2 Pt 2):822-5; discussion 826-7
references.pmid: 8022024