Treatment of genuine stress incontinence

Ans. is a, b & c i.e. Anterior colporrhaphy; Colposuspension; Pelvic floor exercise; and Sling operation Genuine stress incontinence (GSI) is defined as involuntary loss of urine when intravesical pressure exceeds the maxitnum urethral pressure in the absence of detrusor activity. Etiopathogenesis : In a normal continent woman, the bladder neck and proximal urethra are intra abdominal structures and lie above the pelvic floor in standing position and urethral pressure is more than intra vesical pressure. Any factor which leads to distoion of normal urethro vesical anatomy or decreased urethral pressure leads to GSI like Developmental weakness, child bih trauma, pregnancy (due to increased progesterone which is a relaxant), menopause (it leads to atrophy of suppoing structures), trauma, obesity and following surgeries like Ant. Colporrhaphy, repair of VVF (as they lead to fibrosis of urethra). Management Aim : To restore the function of muscles of Urethro vesical junction. Strengthen the suppo of urethra. Conservative approach : Pelvic floor exercises Drugs Sympathomimetic drugs (a- adrenergic drugs) as they increase tone of urethra and bladder neck.eg. - lmipramine - Ephedrine Paraurethral implants using teflon or periurethral injection of Glutaraldehyde linked collagen. Surgical approach : Principles : * Restoration of normal anatomy. Strengthening the suppo of bladder neck. Increasing the functional length of urethra. Now a days - Laparoscopic colposuspension is also being done.