"It's possible that occult stress urinary incontinence with intrinsic sphincter deficiency
may be more difficult to treat in women with severe anterior vaginal prolapse, but our study sample size was not large enough to show this difference," said Dr.
The procedure cured 84% of 121 patients with isolated anatomic stress urinary incontinence and 75% of 22 patients with isolated intrinsic sphincter deficiency
, defined by a urethral closure pressure of less than 20 cm of water or a leak point pressure of less than 60 cm of water.
Advantages of the Kovac procedure include its ability to treat urethral hypermobility and/or intrinsic sphincter deficiency
The sling is attached to the lower part of the pubic bone so that it is less likely to obstruct or hyperelevate the urethra, he said.
This may indicate an intrinsic sphincter deficiency
"You might want to get the next level of urodynamic testing or let someone else look at those patients, because they might need a sling," he said.
For urinary incontinence, cystoscopy is most useful for gathering information in patients thought to have intrinsic sphincter deficiency
Three had intrinsic sphincter deficiency
, and all achieved urinary continence.
Nearly all patients with a positive cough stress test have genuine stress incontinence, mixed incontinence (genuine stress incontinence with detrusor instability), or intrinsic sphincter deficiency