Advances in Female Urology: Stress Urinary Incontinence and Pelvic Organ Prolapse

ABSTRACT

Pelvic floor disorders, including urinary incontinence and pelvic organ prolapse, are common conditions in women but are under-reported and under-treated. These conditions impose a severe burden of physical and social restrictions, depression and compromised quality of life. There are literally hundreds of surgical procedures used to treat incontinence and prolapse, and they are constantly being revised in ongoing attempts to improve outcomes. Many operations have been developed for stress urinary incontinence but only a few-retropubic colposuspension and sling procedures-have survived and evolved with enough supporting evidence. Although the procedure can be done laparoscopically, results from small case series are conflicting. The technique has been modified greatly from the open approach to use mesh and staples. Pubovaginal slings use a strip of tissue or mesh to support the bladder neck. Although slings have been used in patients who fail primary incontinence surgery, they are becoming more common than primary procedures. Traditional synthetic mesh have a risk of complications of vaginal erosion, urethral erosion, and increased need for removal or revision. A recent modification of the sling, midurethral tension-free vaginal tape, places permanent mesh at the mid-urethra under minimum tension with scarce long-term data. However, appropriate clinical trials and long-term follow-up with all these procedures is specially important in point of the possibility of serious erosion many years later. Concerning the pelvic organ prolapse, there is an increasing interest in the use of synthetic meshes which are at widely used for surgical repair. The use of synthetic meshs may also simplify surgical procedures and reduce operative duration and morbidity. Continuous evaluation is necessary to study replacement synthetic materials which should improve the rate of prolapse recur and complications. Randomized controlled trials are required to determine which surgical procedures and type of prosthesis are most suitable.