Stress Urinary Incontinence (SUI)
Disease Presentation
What is SUI?
- SUI is the most common type of urinary incontinence in women, which is an involuntary leakage of urine during moments of certain physical activity when abdominal pressure increases, such as coughing, sneezing, laughing, or exercising. [1]
- Women with SUI could experience multiple urine leaks every day, resulting in physical activity avoidance, experience of social embarrassment, isolation, and dependence on pads, which can affect social, psychological, familial, occupational, physical, and sexual aspects of a patient’s life.
- However, most patients are silently suffering and not actively seeking treatment largely due to a sense of shame, lack awareness of treatment options, affordability limits, or consider SUI as a natural consequence of aging.[2]
Current Management & Patient Flow
Disease / Symptom Onset
Diagnosis
The diagnosis procedure and criteria for SUI are straightforward and well established, patients can be diagnosed and staged based on disease history, physicals, urine diary, pad test, and urodynamics test. [4]
Mild Disease Management
Mild Disease: Urine leakage, leak only when coughing and sneezing
The majority of mild patients are not actively managing the disease.
For mild patients, lifestyle change, and pelvic floor muscle training are recommended, but adoption/effectiveness is limited.
No drug is available for SUI treatment.
60-70% of patients will eventually progress to the moderate/severe stage if not treated. [5]
Moderate/Severe Disease Management
Moderate: <10g urine leakage, leak when running, laughing, fast walking
Severe: ≥10g urine leakage, leak when even having gentle activities
The most common mid-urethral sling surgery options include retropubic TVT (tension-free vaginal tape) and TVT-O (trans-obturator), both take about 20-30 min with high effectiveness.
Unmet Needs
- Only 9% urinary incontinence patients in China have sought help from HCP’s,
and only 0.7% have visited a specialist. - The disease awareness is very limited (e.g., believe urinary incontinence
is a normal consequence of aging), or some feel embarrassed to see a doctor.
- Lifestyle change or pelvic floor muscle exercise may help some early-stage patients to a certain extent.
- However, these treatments cannot prevent disease progression, and most patients will end up with mid/severe disease.
- Most OTC products on the market lack rigorous clinical study and clinical evidence.
- TVT sling (Tension-free vaginal tape), including retropubic TVT and TVT-O, is the global gold standard for curing SUI;
the 10-year effective rate is >85% with decades of safety evidence. - However, surgery treatments have not been broadly adopted, largely due to limited awareness of the disease and treatment,
fear for surgery, or affordability concerns. - Additionally, the ease-of-use and error-proof attributes of existing TVT products still require improvement to support the
broad adoption of TVT surgery.
Sources
[1]. Aveya IVF. Infertility-A Term That Can Be Dreadful! https://aveya.in/infertility-can-be-dreadful/
[2]. Pizzol, D., Demurtas, J., Celotto, S. et al. Urinary incontinence and quality of life: a systematic review and meta-analysis. Aging Clin Exp Res 33, 25–35 (2021).
[3]. 21st Century Business Herald.
[4]. 2017 Female SUI diagnosis and treatment guideline.
[5]. SUI KOL interview.
[6]. Supported unanimously across international urology groups (SUFU, AUGS, AUA, ICS).