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Female stress urinary incontinence and the mid-urethral sling: is obstruction necessary to achieve dryness?

Abstract：

BACKGROUND:Recently, the American Urogynecologic Society and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction released position statements on the use of mid-urethral slings. The statement offers that the polypropylene mesh mid-urethral sling (retropubic and transobturator) is now the recognized worldwide standard of care for the surgical treatment of stress urinary incontinence. The purpose of the current manuscript is to examine whether the polypropylene mesh mid-urethral sling should be the standard of care. METHODS:Data for this review were acquired by a systematic search of the medical literature. RESULTS:The Trial of Mid-Urethral Slings found that retropubic and transobturator slings were associated with a significant rate of adverse events, despite being comprised of surgeons from high-volume, experienced centers. Stress urinary incontinence is not just a urethral disease due to intrinsic sphincteric deficiency. It can also be related to urethral hypermobility, which in turn is caused by anterior vaginal wall laxity. Often both hypermobility and intrinsic sphincter deficiency coexist. Recognizing the role of anterior vaginal wall support is important to understanding the role of procedures (such as Burch or needle suspension procedures) which have the potential of correcting stress incontinence without affecting voiding parameters. CONCLUSIONS:As a discipline, we need to conceptualize stress incontinence due to urethral hypermobility or intrinsic sphincter deficiency as separate entities and design our procedures to restore the underlying suspected pathology.

journal_name

World J Urol

journal_title

World journal of urology

authors

Dobberfuhl AD,De EJ

doi

10.1007/s00345-015-1600-x

subject

Has Abstract

pub_date

2015-09-01 00:00:00

pages

1243-50

issue

9

eissn

0724-4983

issn

1433-8726

journal_volume

33

pub_type

杂志文章,评审

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