UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

URINARY INCONTINENCE AND TREATMENT APPROACHES

İlker Uçar

İzmir Tepecik Training and Research Hospital, Department of Perinatology, İzmir, Türkiye

Uçar İ. Urinary Incontinence and Treatment Approaches. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.151-156.

ABSTRACT

Urinary incontinence (UI) is a prevalent and distressing condition, particularly among women, with significant impacts on quality of life. Its prevalence increases with age, and despite affecting up to 70% of elderly women, only a minority seek medical attention. Risk factors include advanced age, obesity, parity-especially vaginal delivery-and family history. UI is broadly classified into stress, urge, overflow, and mixed types, with stress urinary incontinence (SUI) being the most common. SUI results from urethral hypermobility or intrinsic sphincter deficiency, while urge incontinence is due to detrusor overactivity. Overflow incontinence typically arises from bladder outlet obstruction or detrusor underactivity.

Management strategies include behavioral, medical, and surgical approaches. First-line treatments often involve lifestyle modifications, pelvic floor muscle training, bladder training, and fluid management. Pharmacologic options are limited for SUI but include topical estrogen and duloxetine in select populations. For urge incontinence, antimuscarinic agents and beta-3 adrenergic agonists (such as mirabegron and vibegron) are widely used. In refractory cases, intravesical botulinum toxin and neuromodulation are effective. Although different treatment options were being tried, these treatments had not yet been established in the literature.

Surgical intervention is generally reserved for moderate-to-severe SUI or mixed incontinence. Midurethral sling procedures (TOT and TVT) are most common, while alternatives such as mini-slings, Burch colposuspension, and urethral bulking agents are considered based on etiology and patient characteristics. Although surgical treatments offer high success rates, complications like mesh erosion, urinary retention, and recurrent incontinence can occur. Patient-specific factors should guide individualized management. UI is a treatable condition, and increased awareness and access to care can significantly improve outcomes.

In conclusion, UI is a multifactorial pathology that poses a serious medical and social burden on women’s health. Treatment should be individualized, taking into account patient characteristics and preferences. A stepwise approach, long-term follow-up, and multidisciplinary collaboration can achieve both symptom control and meaningful improvement in quality of life.

Keywords: Urinary incontinence; Stress incontinence; Overactive bladder; Pelvic floor; Sling surgery; Pharmacotherapy

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