Which intervention is appropriate for stress incontinence due to intrinsic sphincter deficiency (ISD)?

Which intervention is appropriate for stress incontinence due to intrinsic sphincter deficiency (ISD)?

• A. Periurethral bulking injections
• B. Anterior vaginal repair
• C. Bladder retraining
• D. Urge inhibition

Answer: (A)

Focusing on restoring urethral closure directly addresses intrinsic sphincter deficiency. Intrinsic sphincter deficiency means the urethral sphincter itself is weak and cannot stay closed when there’s a rise in intra-abdominal pressure. Periurethral bulking injections place material around the urethra to create a bulge that coapts the urethral lumen, increasing closure pressure and preventing leakage during stress. This targeted approach improves the seal without relying on urethral mobility or detrusor activity. Anterior vaginal repair mainly helps with urethral hypermobility and pelvic floor support, not ISD, so it’s less effective for this mechanism. Bladder retraining and urge inhibition are strategies for overactive bladder or urge incontinence, addressing detrusor overactivity rather than a deficient urethral sphincter.

Focusing on restoring urethral closure directly addresses intrinsic sphincter deficiency. Intrinsic sphincter deficiency means the urethral sphincter itself is weak and cannot stay closed when there’s a rise in intra-abdominal pressure. Periurethral bulking injections place material around the urethra to create a bulge that coapts the urethral lumen, increasing closure pressure and preventing leakage during stress. This targeted approach improves the seal without relying on urethral mobility or detrusor activity.

Anterior vaginal repair mainly helps with urethral hypermobility and pelvic floor support, not ISD, so it’s less effective for this mechanism. Bladder retraining and urge inhibition are strategies for overactive bladder or urge incontinence, addressing detrusor overactivity rather than a deficient urethral sphincter.