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Letter to the Editor: In the Scientific Review of urinary incontinence, Drs Holroyd-Leduc and Straus¹ did not discuss the structure of the connective tissue as a risk factor. For instance, women with decreased collagen content and altered morphology in the pelvic support tissue may be at higher risk of stress incontinence.^2-3 We⁴ reported significant reduction of collagen content in the uterine cervix among women with stress urinary incontinence, regardless of age, parity, body mass index, or tobacco use. This suggests that a systemic defect in collagen production, rather than damage to local collagen in the pelvic floor, may predispose to urinary incontinence.

The letter by Drs Harmanli, Dandolu, and Ashwin was shown to Drs Holroyd-Leduc and Straus, who declined to reply.—ED.

Ozgur H. Harmanli, MD
ozgur.harmanli@temple.edu

Vani Dandolu, MD; Ashwin J. Chatwani, MD
Obstetrics, Gynecology and Reproductive Sciences
Temple University School of Medicine
Philadelphia, Pa

1. Holroyd-Leduc JM, Straus SE. Management of urinary incontinence in women: scientific review. JAMA. 2004;291:986-995. FREE FULL TEXT 2. FitzGerald MP, Mollenhauer J, Hale DS, Benson JT, Brubaker L. Urethral collagen morphologic characteristics among women with genuine stress incontinence. Am J Obstet Gynecol. 2000;182:1565-1574. PUBMED 3. Rechberger T, Postawski K, Jakowicki JA, Gunja-Smith Z, Woessner JF. Role of fascial collagen in stress urinary incontinence. Am J Obstet Gynecol. 1998;179:1511-1514. PUBMED 4. Wong MY, Harmanli OH, Agar M, Dandolu V, Grody MH. Collagen content of nonsupport tissue in pelvic organ prolapse and stress incontinence. Am J Obstet Gynecol. 2003;189:1597-1600. FULL TEXT | PUBMED

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291:2431-2432.

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Management of Urinary Incontinence in Women: Scientific Review
Jayna M. Holroyd-Leduc and Sharon E. Straus
JAMA. 2004;291(8):986-995.
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