Epidemiology

Prevalence increases with age.

Etiology

• Pathomechanism: outlet incompetence
  • Urethral hypermobility: loss of pelvic floor musculature and/or connective tissue support → weak pelvic floor → inability of the urethra to completely close
  • Intrinsic sphincter deficiency
• Risk factors
  • Multipara
  • Pregnancy and vaginal deliveries
  • High-impact activity (e.g., jumping, running, hopping)
  • Menopause
  • Obesity
  • Smoking
  • Chronic cough (e.g., COPD)
  • Prostate or pelvic surgery

Pathophysiology

Clinical features

• Physical activity that causes increased intra-abdominal pressure (e.g., laughing, sneezing, coughing, exercising) leads to loss of urine
• Frequent, predictable, small-volume urine losses with no urge to urinate prior to the leakage

Diagnostics

Treatment

Conservative treatment

• Kegel exercises
  • Strengthen Levator ani
• Lifestyle changes (e.g., weight loss, avoiding alcohol and caffeine, smoking cessation)
• Vaginal pessary

Surgical procedures

• Indicated if conservative treatment does not provide sufficient improvement of symptoms
• Procedure of choice: midurethral sling to elevate the urethra