Genuine Stress Incontinence

Ambulatory trace over 2 minutes.There is leakage of about 20 ml in one epsiodes.The bladder is stable and there is a lot of movement.The patient is bending down and up again.Because the bladder is stable we can make the diagnosis Genuine stress incontinence.

Type 1 incontinence proximal urethral closure pressure >10 5mm from vesical outlet leakage associated with minimal rotational descent of urethra <45 º Type 2 incontinence proximal urethral closure pressure >10 5mm from vesical outlet leakage associated with gross rotational hypermobility >45 º Type 3 incontinence proximal urethral closure pressure <10 5mm from vesical outlet non functioning “open” internal sphincter leakage not necessarilly associated with rotational descent

The main change in understanding which McGuire brings is his finding that stress leakage due to raised abdominal pressure is not related to static urethral pressure profile.

Schematic of x-ray of straining patient with type 1 & 2 leakage. Urethra is driven posteriorly and inferiorly by raised abdominal pressure.