Severe adolescent female stress urinary incontinence (SAFSUI): case report and literature review

Abstract

Severe adolescent female stress urinary incontinence (SAFSUI) can be defined as female adolescents between the ages of 12 and 17 years complaining of involuntary loss of urine multiple times each day during normal activities or sneezing or coughing rather than during sporting activities. An updated review of its likely prevalence, etiology, and management is required. The case of a 15-year-old female adolescent presenting with a 7-year history of SUI resistant to antimuscarinic medications and 18months of intensive physiotherapy prompted this review. Issues of performing physical and urodynamic assessment at this young age were overcome in order to achieve the diagnosis of urodynamic stress incontinence (USI). Failed use of tampons was followed by the insertion of (retropubic) suburethral synthetic tape (SUST) under assisted local anesthetic into tissues deemed softer than the equivalent for an adult female. Whereas occasional urinary incontinence can occur in between 6% and 45% nulliparous adolescents, the prevalence of non-neurogenic SAFSUI is uncertain but more likely rare. Risk factors for the occurrence of more severe AFSUI include obesity, athletic activities or high-impact training, and lung diseases such as cystic fibrosis (CF). This first reported use of a SUST in a patient with SAFSUI proved safe and completely curative. Artificial urinary sphincters, periurethral injectables and pubovaginal slings have been tried previously in equivalent patients. SAFSUI is a relatively rare but physically and emotionally disabling presentation. Multiple conservative options may fail, necessitating surgical management; SUST can prove safe and effective.