Lugo Tania, Leslie Stephen W., Mikes Beverly A., Riggs John
Nassau University Medical Center
Creighton University School of Medicine
Urinary incontinence, defined by the International Continence Association as any involuntary leakage of urine, significantly affects patients' quality of life worldwide and poses a substantial global economic burden. In women, this condition exceeds 60% during their lifetime, with a higher incidence among those who have had children and increasing with age. Types of urinary incontinence include stress, urge, overflow, and mixed incontinence, each with distinct and sometimes overlapping causes. Please see StatPearls' companion resource, "Urinary Incontinence," for more information. Stress urinary incontinence is characterized by the sudden involuntary leakage of urine during activities that increase intra-abdominal pressure, such as exertion, sneezing, coughing, laughing, or straining. This condition arises from a combination of anatomical and physiological factors that disrupt the normal urinary continence control mechanisms. Nonmodifiable risk factors include female sex and White race, whereas modifiable factors include smoking, obesity, and chronic constipation. In women, factors such as pregnancy, multiple vaginal deliveries, menopause, obesity, and pelvic surgeries, such as hysterectomy, are significant contributors to stress urinary incontinence. In addition, pelvic organ prolapse, commonly occurring postmenopausal or after childbirth, is often associated with stress incontinence. Stress incontinence is far less common in men and typically occurs following prostate surgical procedures. A survey conducted between 2005 and 2016 involving over 15,000 women in the United States found that more than half had experienced some form of incontinence, with approximately 25% reporting stress-only urinary incontinence. Although not life-threatening, urinary incontinence profoundly impacts the aging population, necessitating surgical intervention when conservative treatments fail. Stress incontinence imposes substantial financial burdens, with management costs in the United States exceeding $13 billion annually in recent years. Treatment options include conservative and behavioral measures, lifestyle changes, bladder training, Kegel exercises, physical therapy, biofeedback, electrostimulation, pharmacotherapy, pessaries, urethral bulking agents, slings, and various other surgical procedures, including artificial sphincters. This review summarizes the diagnosis and all the various treatment options available for patients with stress urinary incontinence.
尿失禁，国际尿控协会将其定义为尿液的任何不自主泄漏，在全球范围内严重影响患者的生活质量，并带来巨大的全球经济负担。在女性中，这种情况在其一生中超过60%，在有过生育经历的女性中发病率更高，且随年龄增长而增加。尿失禁的类型包括压力性、急迫性、充溢性和混合性尿失禁，每种类型都有不同且有时相互重叠的病因。更多信息请参阅StatPearls的配套资源《尿失禁》。压力性尿失禁的特征是在增加腹内压的活动（如用力、打喷嚏、咳嗽、大笑或用力排便）过程中突然不自主地漏尿。这种情况是由解剖学和生理学因素共同作用导致正常尿控机制受到破坏引起的。不可改变的风险因素包括女性性别和白种人，而可改变的因素包括吸烟、肥胖和慢性便秘。在女性中，怀孕、多次阴道分娩、绝经、肥胖以及盆腔手术（如子宫切除术）等因素是压力性尿失禁的重要促成因素。此外，盆腔器官脱垂通常发生在绝经后或分娩后，常与压力性尿失禁相关。压力性尿失禁在男性中远没有那么常见，通常发生在前列腺手术后。2005年至2016年期间在美国对超过15000名女性进行的一项调查发现，超过一半的女性经历过某种形式的尿失禁，约25%的女性报告仅患有压力性尿失禁。虽然尿失禁不会危及生命，但它对老年人群有深远影响，当保守治疗失败时需要手术干预。压力性尿失禁带来了巨大的经济负担，近年来美国每年的管理成本超过130亿美元。治疗选择包括保守和行为措施、生活方式改变、膀胱训练、凯格尔运动、物理治疗、生物反馈、电刺激、药物治疗、子宫托、尿道填充剂、吊带以及各种其他手术程序，包括人工括约肌。本综述总结了压力性尿失禁患者的诊断方法和所有可用的各种治疗选择。
