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Sphincter Insufficiency: Testing and Treatment

Urinary incontinence may originate at the level of the bladder or the urethra. It is essential to identify the cause(s) of incontinence in order to recommend appropriate therapy. Incontinence occurring at the level of the urethra may be a result of anatomic displacement of a normally functioning urethra (anatomic genuine stress urinary incontinence) in females or intrinsic incompetence of the urethral closure mechanism (intrinsic sphincteric dysfunction) in females or males. Females with intrinsic sphincteric dysfunction commonly have had a previous surgical procedure on or near the urethra, a sympathetic neurologic injury, or myelodysplasia, and urodynamically display an open bladder outlet at rest in the absence of a detrusor contraction with or without a concomitant anatomic abnormality of hypermobility of the bladder neck/urethra. However, standardization of a methodology to determine intrinsic sphincteric dysfunction has not yet been accepted. Since the type of incontinence due to it is nonresistant (passive) urinary leakage, the goal of treatment should be only to coapt the urethra by passive occlusion. There have been various surgical procedures and devices developed which have been used with different degrees of success in augmenting intraurethral pressures to treat this condition, although success is related to proper patient selection, and the lack of a standardization to identify patients with this condition or degrees of it interferes with results of treatment and the ability to compare treatment modalities.