Management of intrinsic sphincteric deficiency in women.

Abstract

We reviewed treatment options for intrinsic sphincteric deficiency in women with an emphasis on safety and efficacy. Using MEDLINE, we comprehensively reviewed literature relevant to management of intrinsic sphincteric deficiency. We focused on peer reviewed articles from 1995 through December 2001 with older articles included for historical purposes. Past and current treatment options for intrinsic sphincteric deficiency fall into the 3 categories of urethral bulking agents, slings and artificial urinary sphincter. The autologous fascial pubovaginal sling continues to be the gold standard but newer sling materials are promising. Less invasive therapies with acceptable efficacy and safety profiles are still needed. Improved understanding of the continence mechanism may lead to new and improved treatment modalities for intrinsic sphincteric deficiency. However, it will be impossible to compare these treatment options with past treatment unless long-term, randomized, multicenter trials with specific definitions of cure and failure are conducted.