Device Therapy for Stress Incontinence

Jennifer T. Pollak and G. Willy Davila

The majority of patients with stress urinary incontinence are successfully managed with surgery; however, not all patients desire surgery, nor are all patients operative candidates. Nonsurgical treatment options include pelvic floor muscle exercises, biofeedback, electrical stimulation, and pharmacologic agents. Anti-incontinence devices serve as another alternative to treat these patients, and include both vaginal and urethral prosthesis (Table 6-1.1; Figure 6-1.1).

These devices have several advantages. Patients who are awaiting surgery or who are not optimal surgical candidates may successfully use these devices. This may be an ideal treatment for women who have only exercise-induced stress incontinence. They may be inserted and removed by the patients themselves. When cared for properly, these devices have minimal complications.

The devices, however, have several disadvantages. They require motivated patients. They should not be used with urinary tract infections, and they may predispose women to infection. Self-removal requires good manual dexterity. Patients at risk for endocarditis should not use these devices.1 Women may also use them temporarily until they complete childbearing.

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