title: [Treatment of the urethral sphincter insufficiency].
abstract: The intrinsic sphincter insufficiency is a cause of stress urinary incontinence. Its definition is clinical and based on urodynamics. It is mostly met with women, in context of the post-obstetrical period or older women in a multifactorial context. For men, it occurs mainly as complication of the surgery of the cancer of prostate or bladder. An initial, clinical and paraclinical assessment allows to confirm the diagnosis of intrinsic sphincter insufficiency, to estimate its severity, and to identify associated mechanisms of incontinence (urethral hypermobility, bladder overactivity) to choose the most adapted treatment. The perineal reeducation is the treatment of first intention in both sexes. At the menopausal woman, the local hormonotherapy is a useful additive. In case of failure or of incomplete efficiency, the treatment of the intrinsic sphincter insufficiency is surgical. Bulking agents, urethral slings, peri-urethral balloons and artificial sphincter are 4 therapeutic options to discuss according to history, the severity of the incontinence, the expectations of the patient.
authors.affiliation: Service d'urologie et transplantation rénale, Aix-Marseille université, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France. Electronic address: romainboissier@hotmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Boissier
authors.forename: G
authors.initials: G
authors.lastname: Karsenty
mesh_terms: D000180:Acrylic Resins / Q000008:administration & dosage; D001672:Biocompatible Materials / Q000008:administration & dosage; D001676:Biofeedback, Psychology; D002404:Catheterization; D003094:Collagen / Q000008:administration & dosage; D000068736:Duloxetine Hydrochloride; D004599:Electric Stimulation Therapy; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D020100:Hydrogels / Q000008:administration & dosage; D007267:Injections; D008297:Male; D008487:Medical History Taking; D010808:Physical Examination; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D033581:Stem Cell Transplantation; D053825:Suburethral Slings; D013876:Thiophenes / Q000627:therapeutic use; D014521:Urethra / Q000033:anatomy & histology / Q000503:physiopathology; D014525:Urethral Stricture / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000628:therapy; D016741:Urinary Sphincter, Artificial; D014563:Urodynamics
chemical_list: D000180:Acrylic Resins; D001672:Biocompatible Materials; D003094:Collagen; D000068736:Duloxetine Hydrochloride; D020100:Hydrogels; D017367:Selective Serotonin Reuptake Inhibitors; D013876:Thiophenes; C528271:Bulkamid; C048470:glutaraldehyde-cross-linked collagen