Anatomic goals in the correction of female stress urinary incontinence

Jacek L. Mostwin, Rene Genadry, Roger Sanders, Andrew Yang

Research output: Contribution to journalReview article

Abstract

The goal of stress incontinence surgery is to prevent opening of the urethra during increases in intra-abdominal pressure. Greater refinements in the understanding of the pathophysiology of incontinence and experience with newer treatments have extended surgical thinking beyond the familiar paradigm 'to place the urethra in a high retropubic position.' When incontinence is associated with vaginal hypermobility, vaginal support may be sufficient to restore continence if the suburethral vaginal wall is sufficiently strong, an evaluation which must often be made by physical examination alone. However, when the vaginal wall is weak, the urethra will require an alternative form of support, usually a sling. If the urethra is intrinsically deficient, vaginal support may not be sufficient to prevent opening during increased intra-abdominal pressure, and coaptation by sling obstruction or periurethral bulking injection may be required. Most laparoscopic approaches to stress incontinence use Burch's method, which offers excellent urethral stability provided the suburethral vaginal wall is strong. Newer insights into the relation between vaginal mobility and urethral closure are discussed, as well as anatomic aspects of the Burch suspension relevant to laparoscopic repair.

Original languageEnglish (US)
Pages (from-to)207-212
Number of pages6
JournalJournal of Endourology
Volume10
Issue number3
DOIs
StatePublished - Jun 1996

ASJC Scopus subject areas

  • Urology

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