SUI (Stress urinary incontinence): Stress urinary incontinence refers to involuntary urine
leakage due to physical extension, sneezing or coughing. It is the most common type of
urinary incontinence disorder, commonly affecting upto 30% of women. SUI is the most
common type of urinary incontinence in women presenting with the symptoms of
incontinence.

TYPES:
Type 1: Incontinence due to loss of posterior urethrovesical angle alone
Type 2: Incontinence due to loss of posterior urethrovesical angle as well as urethral
hypermobility.
Type 3: Incontinence due to ISD (Intrinsic sphincteric deficiency).

GRADES:

1. Grade 0: Incontinence without leakage.
2. Grade 1: Incontinence with only severe stress such as coughing, sneezing and
   jogging.
3. Grade 2: Incontinence with moderate stress, such as fast walk, going up and down
   the stairs.
4. Grade 3: Incontinence with mild stress such as standing.

RISK FACTORS:
The risk factors for SUI includes advancing age, pregnancy, child birth, chronic cough,
prolapse, constipation, smoking and obesity. SUI is caused by weakening of endopelvic
fascia and supportive tissues around the urethra and sphincter, unable to withstand normal
pelvic pressure and causing uncontrolled urine leakage.Currently there are a variety of treatment options including bladder training, pelvic floor
training with electrical stimulation, surgical procedures, absorbant products, occlusivedevices, pharmaceutical therapy and thermal therapy. The Gold standard treatment is surgical correction which results in 90% of improvement rates. As an alternative treatment,
to surgical methods, minimally invasive thermal therapy devices can deliver energy into
target tissue to generate heat and cause tissue stiffening and remodeling. Higher temperatures (>50 0C) and thermal doses can be applied for direct tissue tightening due to thermally induced collagen shortening and shrinkage, or necrosis and subsequent
remodeling and lower temperature and thermal doses can be applied for subtler tissue modulation without tissue damage, stiffening, fibrosis as well as neo-collagenesis.Non-invasive laser ablation is one form of thermal therapy that has been utilized for many
applications such as skin rejuvenation, resurfacing through protein denaturation and collagen contraction. Recent studies reported laser-induced tissue degeneration and shrinkage can be used to remodel endopelvic fascia for treating SUI by using transurethral or transvaginal application.

Trans urethral radio frequency (RF) current heating devices, which deliver energy to the
proximal urethra or bladder neck region to tighten the endopelvic fascia, which has been reported to improve SUI symptoms. Trans urethral energy source that focus an target tissue regions adjacent to the mid-urethra is required. The targeted treatment region includes
endopelvic fascia, pubourethral ligaments, the levator ani and other adjacent connective tissues and ligaments lateral to urethra. Thermal treatment that tightens the tissue may produce a biologic “hammock” by remodeling collagen and connective tissue and increasing hydrostatic pressure.

MECHANISM:
The mechanism of HIFU, the therapeutic action takes two forms:

1. Conversion of mechanical energy into heat (causes the tissue to heat up and kills the
   cell)
2. Mechanical cavitation of pressure waves in tissues (causes the tissue to vibrate and
   mechanically stress the cells, causing them to also die)
3. HIFU uses high- energy ultrasound waves to destroy tissue at focal point of a
   transducer without injuring the intervening tissue.
4. This parabolic configuration focuses these sound waves into discrete focal point
   measuring approximately 3mm x 3mm x 11 mm
   Strong ultrasound waves in the audible sound range and approximately 10,000 times
   stronger than diagnostic ultrasound are generated by a transducer with a parabolic
   configuration. It can be 2 types depending of treatment site.
   ▪ Non-invasive (transcutaneous)
   ▪ Minimally invasive (transrectal)

MEDICAL USES :
Therapeutic applications use ultrasound to bring heat or agitation into the body. Focused ultrasound may be used to generate highly localized heating to treat cysts and tumors either benign or malignant. This is known as FOCUSED ULTRASOUND SURGERY (FUS) or HIGH
INTENSITY FOCUSED ULTRASOUND (HIFU). HIFU treatment is often guided by MRI. The
other uses are:
❖ Break up kidney stones by lithotripsy.
❖ Cataract treatment by phacoemulsification.
❖ Its ability to stimulate bone growth.
❖ Its potential to disrupt the blood-brain barrier for drug delivery.
❖ Non-invasive treatment options for patients suffering from symptomatic fibroids
❖ Benign thyroid nodules and hypertrophic parathyroid glands ablation.
❖ Breast fibroadenoma ablation.
❖ Non-invasive treatment of various brain disorders such as neuropathic pain and
Parkinson’s disease.
❖ Body contouring

COMPLICATIONS:
Complications after primary therapy with HIFU are:
➢ UTI (Urinary stress incontinence).
➢ Rectal burn and rectourethral fistula retention.
➢ Urethral and bladder neck Stenosis or strictures