Female stress urinary incontinence due to intrinsic sphincteric deficiency: recognition and management.

PURPOSE: The recent literature on intrinsic sphincteric deficiency is reviewed.
MATERIALS AND METHODS: We performed an extensive literature search related to the diagnosis, management and treatment of intrinsic sphincteric deficiency.
RESULTS: Stress urinary incontinence results from insufficient urethral resistance and/or support during increases in intra-abdominal pressure. Since treatment of stress urinary incontinence is closely related to the mechanism of urinary leakage, recognition of intrinsic sphincteric deficiency is of the utmost importance in its evaluation. Furthermore, to date there is no consensus on the treatment of intrinsic sphincteric deficiency and various procedures may be considered.
CONCLUSIONS: The pathophysiology of urinary incontinence in female patients is still controversial. Intrinsic sphincteric deficiency is best recognized by history and clinical examination in conjunction with documentation of severe stress urinary incontinence, a fixed urethra and a low Valsalva leak point pressure. The pubo-vaginal sling procedure still represents the most widely accepted treatment to correct intrinsic sphincteric deficiency.