ORIGINAL ARTICLE Severe adolescent female stress urinary incontinence (SAFSUI): case report and literature review Bernard T. Haylen & Dianne Avery & Tin Lok Chiu Received: 12 June 2013 /Accepted: 27 August 2013 /Published online: 13 September 2013 # The International Urogynecological Association 2013 Abstract Introduction Severe adolescent female stress urinary inconti- nence (SAFSUI) can be defined as female adolescents be- tween 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. Materials and methods The case of a 15-year-old female adolescent presenting with a 7-year history of SUI resistant to antimuscarinic medications and 18 months 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. Results 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 equiva- lent patients. Conclusions 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. Keywords Adolescent female . Stress urinary incontinence . Suburethral tape . Continence surgery Introduction The symptom of stress urinary incontinence (SUI) is defined [1] as involuntary loss of urine on effort or on physical exertion (e.g., sporting activities) or on coughing or sneezing. Adolescent female (AF) refers to adolescent women between the ages 12 and 17 years [2]. Risk factors for the occurrence of adolescent female SUI (AFSUI) include obesity [2], athletic activities [3, 4] or high-impact training [5], lung diseases such as cystic fibrosis (CF) [6], and neurologic disturbances [7] such as myelomeningocele, spina bifida and spinal cord inju- ry. Clinically significant SUI has been defined [2] as that occurring at least once weekly. Severe SUI can be defined as that occurring more than once daily [8] with normal activities (including sneezing or coughing) rather than sporting exer- tion. Severe adolescent female stress urinary incontinence (SAFSUI) is an entity not previously defined. Clinically, conservative management may be ineffective and surgical options may become a consideration. Synthetic tapes [9] inserted suburethrally (SUSTs) have become the mainstay of treatment for severe female SUI, though we have found no reports of their use in adolescents. Case report A 15-year-old Caucasian adolescent female was referred by her general medical practitioner (GP) with “the distressing symptom of stress incontinence of at least 7 years’ duration, extensively investigated with ultrasound (renal and pelvic), B. T. Haylen (*) St Vincent’ s Clinic, Suite 904, 438 Victoria Street, Darlinghurst 2010, NSW, Australia e-mail: bernard@haylen.co D. Avery : T. L. Chiu St Vincent’ s Hospital, Darlinghurst, NSW, Australia Int Urogynecol J (2014) 25:393–396 DOI 10.1007/s00192-013-2220-x