Parulekar SV
I am happy that JPGO has
successfully completed two years of publication. It has been possible only
because of the enthusiasm and efforts of the authors and the encouragement
received from all over the world. In fact, JPGO gets more readers from countries
other than the country of its origin and publication. Maintaining the quality
and regularity of publication was not easy in face of self funding and entirely
voluntary work of the editors and reviewers. I am happy that we achieved what
we set out to do two years ago. I am also satisfied that we could share the
clinical experience, innovations and original ideas of our contributors with
the world without asking anyone to pay for it.
Urinary stress incontinence (SUI)
is a condition in which there is an involuntary loss of urine on Valsalva’
maneuver in the form of effort, physical exertion, sneezing, or coughing. It is a far more common problem in the lives of
women than meets the eye. More than 50% of all women are affected by urinary
incontinence at some time in their lives. At any given time it affects about
15% of all adult women. Among the women affected by SUI, about 75% have
bothersome symptoms, and of these women, about 30% have moderate to extremely severe
symptoms. The effects of SUI on a woman’s life can be varied. The smell of
urine around her can cause a disruption of social relationships. The anxiety, embarrassment,
and lowered self-esteem associated with SUI can cause significant psychological
distress. There can be disruption of sexual life due to urinary incontinence
occurring during sexual activity. Skin ulceration and urinary infection
associated with severe SUI may necessitate hospitalization for management. Many
cases go unreported and untreated because of the women’s embarrassment to discuss
the issue and failure of the treating physicians to ask specific questions
aimed at detecting SUI.
There are different
pathophysiological mechanisms that cause SUI. Weakening of the pelvic fascial
support under the urethra is the commonest cause. It may be due to childbirth
trauma to the fascia or weakening due to postmenopausal atrophy. Childbirth
trauma can also cause damage to the pudendal nerve, weakening the muscular
component of the support. In such cases there is no resistance to downward
displacement of the urethra with Valsalva’s maneuver, intraabdominal pressure
gets transmitted to the bladder but not the urethra which has been displaced
below the level of the urogenital diaphragm, intravesical pressure exceeds
intraurethral pressure and SUI occurs. Another cause of SUI is a failure of the
urethral sphincter to close properly as a result of a weak striated muscles
around the bladder neck. In a case of SUI of any etiology, the symptoms may be
masked if the woman develops pelvic organ prolapse (POP) later on. If the
prolapse if of long duration, she may forget that she had SUI. If the
gynecologist does not ask her about a history of SUI in past, the condition
remains undetected, and will manifest after surgical repair of the POP. This is
entirely unavoidable. In this issue we have an article on SUI, in which a so
far unreported cause of development of SUI – a vaginal wall cyst - which caused manifestation of SUI after
surgery, is discussed. I hope it helps prevent postoperative SUI in some women
who suffer from such a condition.