الفهرس 
Functional female pelvic anatomyOnly 14 pages are availabe for public view
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Abstract
The problem of stress urinary incontinence (SUI) had
been discussed in literature for more than a century ago, and hitherto debate never stopped as regard the functional
anatomy, pathophysiology, standard diagnostic
investigations, besides the appropriate treatment.
However, it is currently accepted that the condition of SUI
may result from either: a defective anatomical support, a
deficient intrinsic sphincteric mechanism, or a combination
of both factors.
Diagnosis of the anatomical malposition is relatively a
simple task which could be accomplished via physical
examination, simple bedside tests, and radiographic
appearance of the urethral axis at rest and stress.
Unveiling intrinsic sphincter deficiency(ISD) is more
difficult, counting on history of previous pelvic surgery,
open bladder neck and proximal urethra at rest, low closing
urethral pressure, and below 60 cm H2O Valsalva leak
point pressure. The stretch made to settle the
pathophysiology dictates the surgical management.
Since 1900 more than 150 treatment modality had
been evolved without universal acception for a single
procedure. One of these options is periurethral injection of
Summary & Conclusion
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a bulking agents, which had been practiced for more than
25 years. They were indicated for patients of ISD coupled to
fixed urethra, however recent studies concerned its use in
patients with urethral hypermobility as well. A lot of
injectable materials were used. Polytetrafluoroethylene
(Teflon), and glutaraldehyde cross linked collagen
(Contigen) were among the most commonly used, whereas
periurethral fat injection is comparatively recently
admitted. The safety of Teflon was questionable due to
documented distant migration, while collagen had the
disadvantage of degradation, immunogenic reactions, and
the extremely high cost. Fat as an injectable, offers the
privilege of being cheap, biocompatible, and readily
available, though still it has the disadvantage of resorption.
The treatment outcome for stress incontinence varies
widely in literature due to lack of standard objective
parameters quantitating the postoperative improvement.
Valsalva leak point pressure (VLPP) was advocated as a
simple reproducible objective test, so long the methodology
is invariable. It provides a measure for preoperative
assessment, to be compared with postoperative follow up
values.
In this study periurethral fat injections were offered
to 50 female patients -diagnosed urodynamically as SUIirrespective
to the patient’s type. Nine patients were
Summary & Conclusion
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missed during follow-up and the 41 patients had an overall
success rate of 63.4% after an average number of 2.8
injections for 9 months following the last injection. The
success rate showed no significant statistical difference
between the 3 types of SUI, and was significantly related to
preoperative lower values of: VLPP, maximum urethral
closure pressure (MUCP) and functional urethral length
(FUL). Postoperative urodynamic follow-up revealed
significant increase in VLPP and FUL. Retrospective
correlation of FUL and MUCP to SUI type showed
significant difference between the 3 types in the former and
between type III and the other 2 types in the second.
Hence, it is concluded that:
· Periurethral fat injection had a success rate
comparable to other injectables on the short term level.
· Periurethral injections could be used in patients with
urethral hypermobility as well.
· VLPP is an easy valuable tool in predicting success
and as a follow-up parameter, though it was observed
that the surroundings to the patient may alter the
result. Trials for coupled EMG is recommended
· Assessing urethral pressure profile conditioned with 250 ml filled bladder in the sitting position in SUI
patients needs reconsideration.