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Surgery for Stress Urinary Incontinence and Pelvic Organ Prolapse

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Bladder Dysfunction in the Adult

Part of the book series: Current Clinical Urology ((CCU))

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Abstract

The pathophysiology of stress urinary incontinence (SUI) has been traced to a deficiency of support at the bladder neck and mid-urethra. Several categories of surgical procedures have been introduced throughout the years to address the support weakness, with each operation having a wide reported range of anatomic outcomes and complications. While the definitions of cure vary and there is an overall paucity of randomized controlled trials, the pubovaginal sling and the retropubic mid-urethral sling have emerged as the procedures of choice for women with SUI. Pelvic organ prolapse likewise occurs due to a weakness of supportive tissues around the potential space of the vagina. Approaches to repair may be vaginal, abdominal, or laparoscopic, with robotic-assisted techniques rapidly expanding. Furthermore, techniques may utilize native tissue or augmentation with allografts, xenografts, or synthetic materials. In the anterior compartment, augmentation with synthetic transvaginal mesh leads to an improved anatomic outcome, while subjective improvement is similar to native tissue repairs. Objective and subjective outcomes appear to be similar for mesh-augmented and native tissue repairs in the posterior compartment. Mesh augmentation carries the risk of mesh extrusion or erosion.

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Author information

Authors and Affiliations

  1. Department of Urology, LSU Health—Shreveport, Shreveport, LA, USA

    Alex Gomelsky M.D.

  2. Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, TN, 37232-2765, USA

    Roger R. Dmochowski M.D., M.M.H.C.

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  1. Alex Gomelsky M.D.
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  2. Roger R. Dmochowski M.D., M.M.H.C.
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Correspondence to Roger R. Dmochowski M.D., M.M.H.C. .

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Editors and Affiliations

  1. Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA

    Alan J. Wein

  2. Aarhus University, AIAS, Aarhus Institute of Advanced Studies, Aarhus, Denmark

    Karl-Erik Andersson

  3. Urological Institute, University of Bristol and Bristol, Bristol, United Kingdom

    Marcus J. Drake

  4. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA

    Roger R. Dmochowski

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Gomelsky, A., Dmochowski, R.R. (2014). Surgery for Stress Urinary Incontinence and Pelvic Organ Prolapse. In: Wein, A., Andersson, KE., Drake, M., Dmochowski, R. (eds) Bladder Dysfunction in the Adult. Current Clinical Urology. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-0853-0_16

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  • DOI: https://doi.org/10.1007/978-1-4939-0853-0_16

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