Stress Urinary Incontinence ( SUI ) is the uncontrollable leakage of urine on exertion, such as running, jumping, sneezing, laughing and coughing. Associated causes include child-birth, menopause, obesity, chronic lifting of heavy loads, chronic cough and constipation.
A national survey on 3500 females in Singapore by Dr Christopher Chong revealed that 13.5% suffered from SUI and a shocking 35.8% in the above 50 age group; more than 1 out of 3 females above 50 years old suffer from SUI.
This is probably under-reported. This equates to about 190 000 females in Singapore. It is estimated that to date, less than 30 000 have sought treatment for this problem. Also from the survey, the reasons for this low treatment level were that majority of the females were too embarrassed to talk about urinary incontinence (even with close friends or relatives), did not know that it is a problem, did not know that it can be treated, and did not know where to seek treatment. Many, sadly, accepted it as part of growing old.
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SUI is linked to pelvic organ prolapse: 50% of patients with pelvic organ prolapse have SUI, and 50% of SUI patients have pelvic organ prolapse. In that sense, a lady above the age of 50 will be expected to have at least a 50% ( 1 in 2 ) chance of either SUI or pelvic organ prolapse!! A Screening Clinic is available to screen out such problems, and a Prevention Clinic to teach patients how to prevent these problems. Pelvic floor exercises can prevent SUI, and mild SUI can be cured with pelvic floor exercises.
The Tension-free Sling Surgery is now the accepted surgery of choice in the treatment of SUI. The technique using the Tension-free Vgainal Tape ( TVT ) has been used in Singapore since 1998. My colleague and I were the first few Urogynaecologists ( most Gynaecologists are not trained in this technique ) in Asia to perform this surgery. To date, the 2 of us, combined, had done 10 00 cases. Our cases from more than 20 years ago are in the vast majority, still doing very well. A new technique called TVT-O had been popular in the last 10 years. It uses a polypropylene mesh tape placed around the middle part of the bladder neck without any tension or stitches. The exit point is not through the abdomen but the inner thigh. When a person strains, the bladder neck pushes onto the tape and closes, thus preventing urine leakage. This tape is left permanently in the body. This new technique has advantages over the older ones. There is less risk of bleeding and injury to the bladder, and cystoscopy ( putting a scope into the bladder ) to check for bladder damage and perforation need not be routinely done. This surgery can be done as a day procedure, and the patient can be up and about the same day.
Though minimal, complications include voiding problem ( less than 1% ), erosion of the mesh through the vagina, infection, bleeding, bladder injury, and thigh pain. Quoted success rates are in the region of 95%.
To further reduce complications such as thigh pain, new techniques have been tried. These include new tapes which do not have exit points through the thigh. Unfortunately, the success rate of the first 30 cases done in Singapore was 67%. International review data quoted success rates of 65% to 82%. This shows that not all new methods are good – new methods must withstand the test of time.
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People with SUI should seek treatment early. This is important as the more severe the condition, the lower the success rate from surgery.
There are many SUI surgeries, ranging from 30 – 40% success rate for some old surgeries to over 90% for some newer ones. Hence, it is very important to select the correct and best surgery for SUI. This is especially so as the success rate for SUI surgery fall with each subsequent surgery. It is important to educate that SUI is very common but can easily be treated with minimal pain, minimal complications in good hands, and high success rates. Women must not go on suffering. They should get back to normal life, to laugh and jump without the fear of SUI.
In conclusion, on top of all the many ‘Cs’ that we aim for, all females should aim for another ‘C’ – that is, CONTINENCE!
Dr Christopher Chong is a pioneer in Incontinence, Prolapse and Pelvic Reconstruction Surgery, being one of the first Urogynaecologist in Asia to perform such surgeries and has performed thousands of such surgeries to date.