Transvaginal surgery for stress urinary incontinence

Tracey S. Wilson, Gary E Lemack

Research output: Chapter in Book/Report/Conference proceedingChapter

3 Scopus citations

Abstract

Stress urinary incontinence is the involuntary loss of urine related to increases in abdominal pressure. It has been suggested that urethral hypermobility and/or intrinsic sphincter deficiency (ISD) contribute to most forms of stress urinary incontinence. Urethral hypermobility results when the vaginal musculofascial attachments that support the bladder neck and urethra in a retropubic position lose integrity. On increases in abdominal pressure, this loss causes the proximal urethra and bladder neck to descend into the vagina. ISD, on the other hand, refers to a deficiency in the function of the urethral sphincter that is unrelated to urethral support [1]. This leads to poor coaptation of the urethral mucosa and incontinence with minimal stress activities. Intrinsic sphincteric weakness can result from neurologic deficit, or it may merely be a secondary effect of aging. ISD may also be related to previous attempts at surgical repair or exposure to pelvic radiation. DeLancey proposed a unifying theory known as the “hammock hypothesis” that suggests that a poor muscular backing to the posterior aspect of the urethra results in failure of effective urethral coaptation, excessive urethral mobility, and urinary leakage [2].

Original languageEnglish (US)
Title of host publicationFemale Pelvic Health and Reconstructive Surgery
PublisherCRC Press
Pages137-160
Number of pages24
ISBN (Electronic)9780824743611
ISBN (Print)9780824708221
StatePublished - Jan 1 2002

ASJC Scopus subject areas

  • Medicine(all)

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