Stress urinary incontinence among women. Aspects of risk factors, evaluation and surgical treatment.

The etiology of female stress urinary incontinence (SUI) is unclear. By linking three nationwide medical registries we evaluated maternal and obstetric factors associated with later SUI surgery. Surgery for SUI was strongly associated with vaginal delivery, but not with pregnancy as such. Maternal conditions and interventions during delivery modified the association. Proper evaluation of treatment of SUI requires an objective outcome measure. In an experimental study we found a novel ultrashort perineal pad-test to sufficiently meet with requirements for such a test in terms of reproducibility and feasibility. During recent years less invasive modifications of traditional surgical methods for SUI have been introduced. In two prospective studies on laparoscopic colposuspension, objective outcome, urodynamic correlates, and suturing techniques were assessed. Short term cure rate was 82% and 83% respectively when 2 sutures were used on each side of the urethra. Women randomized to one suture on each side of the urethra had significantly lower cure rate (59%). Short preoperative urethral functional length was associated with failure. In a retrospective case control study, we wanted to identify variables associated with rejection of synthetic suburethral slings used for SUI surgery. Rejection was independently and negatively associated with appropriate antibiotic prophylaxis and with the surgeon performing the operation. In a prospective randomized study, total cost to the county (hospital owner) for Tension-free Vaginal Tape (TVT) was found higher than for laparoscopic colposuspension. The charges for anesthesia time and the investment cost for the disposable TVT kit were the most cost deciding factors