Which aspects of the patient’s history are important in differentiating GSI and DI?
WithGSI, the patient often complains of loss ofurine with physical activity, such coughing , sneezing, climbing stairs, laughing, bouncing, and intercourse. Urine loss is instantaneous. In DI, women typically complain of urgency followed by a large loss of urine.
What are the surgical outcomes ?
The traditional vaginal approach to stress incontinence has been the Kelly plication,but recent studies have suggested that it does not provide adequate long-term support of the urethrovesical junction.The cure rate for stree incontinence following anterior colporrhaphy ( for cystocele ) is only 40%.
Treatment of stress urinary incontinence resulting from urethral hypermobility is best performed with the Marshall-Marchetti-Krantz or Burch procedure,both of which have an overall success rate of 85 %.Surgical failures often result from inadequate preoperative evaluation of the cause of incontinence.
The success rate of the suburethral sling procedure to treat intrinsic urethral sphincter dysfunction is 80~90 %.Periurethral bulking injections with GAX-collagen have a lower success rate of 45~65 %.
From:OBS/GYN SECRETS Third EDition