Parulekar SV

I am happy that JPGO has successfully completed two years of publication. It has been possible only because of the enthusiasm and efforts of the authors and the encouragement received from all over the world. In fact, JPGO gets more readers from countries other than the country of its origin and publication. Maintaining the quality and regularity of publication was not easy in face of self funding and entirely voluntary work of the editors and reviewers. I am happy that we achieved what we set out to do two years ago. I am also satisfied that we could share the clinical experience, innovations and original ideas of our contributors with the world without asking anyone to pay for it.

Urinary stress incontinence (SUI) is a condition in which there is an involuntary loss of urine on Valsalva’ maneuver in the form of effort, physical exertion, sneezing, or coughing. It  is a far more common problem in the lives of women than meets the eye. More than 50% of all women are affected by urinary incontinence at some time in their lives. At any given time it affects about 15% of all adult women. Among the women affected by SUI, about 75% have bothersome symptoms, and of these women, about 30% have moderate to extremely severe symptoms. The effects of SUI on a woman’s life can be varied. The smell of urine around her can cause a disruption of social relationships. The anxiety, embarrassment, and lowered self-esteem associated with SUI can cause significant psychological distress. There can be disruption of sexual life due to urinary incontinence occurring during sexual activity. Skin ulceration and urinary infection associated with severe SUI may necessitate hospitalization for management. Many cases go unreported and untreated because of the women’s embarrassment to discuss the issue and failure of the treating physicians to ask specific questions aimed at detecting SUI.

There are different pathophysiological mechanisms that cause SUI. Weakening of the pelvic fascial support under the urethra is the commonest cause. It may be due to childbirth trauma to the fascia or weakening due to postmenopausal atrophy. Childbirth trauma can also cause damage to the pudendal nerve, weakening the muscular component of the support. In such cases there is no resistance to downward displacement of the urethra with Valsalva’s maneuver, intraabdominal pressure gets transmitted to the bladder but not the urethra which has been displaced below the level of the urogenital diaphragm, intravesical pressure exceeds intraurethral pressure and SUI occurs. Another cause of SUI is a failure of the urethral sphincter to close properly as a result of a weak striated muscles around the bladder neck. In a case of SUI of any etiology, the symptoms may be masked if the woman develops pelvic organ prolapse (POP) later on. If the prolapse if of long duration, she may forget that she had SUI. If the gynecologist does not ask her about a history of SUI in past, the condition remains undetected, and will manifest after surgical repair of the POP. This is entirely unavoidable. In this issue we have an article on SUI, in which a so far unreported cause of development of SUI – a vaginal wall cyst -  which caused manifestation of SUI after surgery, is discussed. I hope it helps prevent postoperative SUI in some women who suffer from such a condition.