Treatment options for women with stress urinary incontinence

About one-quarter million surgical procedures are performed each year in th e United States for stress urinary incontinence. After outlining the presen tation and diagnostic evaluation of stress urinary incontinence, this revie w concentrates specifically on the numerous conservative management strateg ies and minimally invasive surgical options for women with this common comp laint. In the evaluation of nursing home residents with incontinence, the M inimum Data Set and Resident Assessment Protocol facilitate nonspecialist e valuation and management. In healthy adults, the therapeutic implications o f the physical examination of the pelvic floor, assessing for the presence and strength of the voluntary contraction of the pelvic floor muscles, are detailed as the basis for all con servative management strategies. Reports on the effectiveness of pelvic floor muscle reeducation and pelvic floor el ectrical stimulation vary substantially, as do long-term results of surgica l interventions. Surgical management is highly effective in the appropriate candidate, The current theory and practice of surgical treatment of stress urinary incontinence are outlined, with certain caveats regarding the lack of long-term follow-up for newer less invasive techniques.