Chapter 143 - Female stress urinary incontinence surgery

Summary

It is estimated that more than 20 million American women have moderate or severe stress urinary incontinence. Despite the negative impact on quality of life, many patients are slow to complain and fail to seek medical care – a typical patient will suffer symptoms for more than 7 years before talking to a physician. For the elderly, problems of incontinence often weigh heavily towards institutional care.

There are many causes for stress urinary incontinence, and surgery is not always needed to resolve it.

Current practice guidelines clearly promote non-surgical therapies first, and pelvic floor muscle exercises are often effective, notably when combined with fluid regulation, diet, and bowel management, because bladder control is always better when the lower bowel is empty. Surgery should be reserved for those who have failed these methods, and have severe or moderate incontinence that can be demonstrated on examination.

Pelvic support anatomy varies widely from patient to patient: some pelvic floors are versatile and balanced; others are asymmetrical and incomplete, causing problems of bladder control, pelvic organ prolapse, and bowel dysfunction. Bladder, bowel, and vaginal prolapse problems may occur in the same patient, and other female family members are likely to be similarly afflicted. Acquired diseases with a role in promoting stress urinary incontinence include diabetes, lumbar or cervical disc disease, and spinal stenosis, as well as a history of pelvic floor insults such as vaginal delivery, hysterectomy, and other pelvic surgery. Surgical procedures in the abdomen or retroperitoneum may also disturb bladder function, and a history of radiation therapy or peripheral neuropathy may compromise surgical treatments.