Transvaginal surgery for stress urinary incontinence owing to urethral hypermobility

Christina Poon, Philippe E. Zimmern

Research output: Chapter in Book/Report/Conference proceedingChapter

5 Scopus citations

Abstract

Ideally, the choice of surgery for stress urinary incontinence should be determined by the underlying pathophysiology. Generally, the diagnosis is refined to either urethral hypermobility (UHM) or intrinsic sphincteric dysfunction (ISD) based on history, questionnaires, physical exam, and various special tests including assessment of urethral mobility (Q-tip test or lateral cystogram), stress test, pad test, and video or nonvideo urodynamic studies. Unfortunately, there is no gold standard test or algorithm to allow diagnostic precision in every case, and the diagnosis is usually arrived at based on various combinations of the above investigations along with clinical acumen and experience. Nonetheless, the importance of arriving at the correct diagnosis lies in its role in determining the appropriate surgical intervention. Although this principle of practice has been challenged more and more in recent years (1,2), traditionally, UHM is treated with one of the bladder neck suspensions (BNSs) and ISD with one of the sling procedures, urethral bulking agents, or artificial urinary sphincter. For UHM, once the diagnosis is made, one must decide on the appropriate BNS, for which there exist two main types based on surgical approach: retropubic or transvaginal. Differences in efficacy aside, the decision to proceed with one approach or the other should be driven by any associated pathology requiring concomitant surgical repair. For example, if concomitant vaginal repair of a symptomatic rectocele is undertaken, then a transvaginal anti-incontinence procedure is appropriate. Conversely, if an abdominal hysterectomy is required, then a retropubic approach is logical.

Original languageEnglish (US)
Title of host publicationVaginal Surgery for Incontinence and Prolapse
PublisherSpringer London
Pages91-107
Number of pages17
ISBN (Print)1852339128, 9781852339128
DOIs
StatePublished - Dec 1 2006

ASJC Scopus subject areas

  • Medicine(all)

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    Poon, C., & Zimmern, P. E. (2006). Transvaginal surgery for stress urinary incontinence owing to urethral hypermobility. In Vaginal Surgery for Incontinence and Prolapse (pp. 91-107). Springer London. https://doi.org/10.1007/978-1-84628-346-8_8