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Surgical management of stress urinary incontinence in women: Choosing a primary surgical procedure

Authors
J Eric Jelovsek, MD, MMEd, FACOG, FACS
Jhansi Reddy, MD
Section Editor
Linda Brubaker, MD, FACS, FACOG
Deputy Editor
Kristen Eckler, MD, FACOG

INTRODUCTION

Stress urinary incontinence (SUI), the involuntary leakage of urine on effort or exertion, or on sneezing or coughing, affects 4 to 35 percent of women [1-3]. Conservative approaches to treatment of SUI include pelvic floor muscle training and incontinence pessaries. However, for women who decline or have insufficient improvement following conservative therapy, there are a variety of surgical treatments. The introduction of midurethral slings has changed the decision process for surgical treatment and is likely a factor in the increase in the rate of anti-incontinence surgery in the United States from 0.8/1000 women in 1979 to 1.0/1000 in 2006 [4-6].

The process of choosing a surgical procedure for women with SUI who have not had a prior anti-incontinence surgery will be reviewed here. Choosing a type midurethral sling, nonsurgical management of SUI, treatment of recurrent SUI, and diagnosis and treatment of other types of urinary incontinence are discussed separately. (See "Surgical management of stress urinary incontinence in women: Choosing a type of midurethral sling" and "Treatment of urinary incontinence in women" and "Stress urinary incontinence in women: Persistent/recurrent symptoms after surgical treatment" and "Evaluation of women with urinary incontinence".)

TERMINOLOGY

Terminology used throughout this topic review is defined here (table 1):

Stress urinary incontinence (SUI) – Involuntary leakage of urine on effort or exertion, or on sneezing or coughing [1].

Suburethral sling – A suburethral sling is a sling that is inserted through a small vaginal incision and placed either at the bladder neck, midurethra or proximal urethra for the purpose of supporting the urethra in women with SUI. This category includes both bladder neck and midurethral slings.

                          

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Literature review current through: Nov 2016. | This topic last updated: Fri Oct 14 00:00:00 GMT 2016.
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