Recent Trends in the Surgical Treatment of Female Stress Urinary Incontinence / 대한비뇨기과학회지

ABSTRACT

Recent improvement in the understanding of the continence mechanism in women have led to the development of innovative new surgical methods. Nearly 300 procedures have been proposed for the surgical treatment of stress urinary incontinence (SUI) in women. Three groups of surgical procedures and their variants have been utilized over the past decades urethropexy, colposuspension and the sling. Many are less invasive than previous techniques and appear to offer improved safety and shorter hospital stays, while maintaining the efficacy of traditional open anti-incontinence surgery. Burch colposuspension and sling procedures still are the main stream but recently tension-free vaginal tape procedure and its variants are developed and widely performed all over the world. Pathophysiological concepts and theories on clinical staging have changed in recent years. The importance of pressure transmission and hammock- like support has been complemented by the so-called 'integral theory'. Loosely applied polyprophylene mid-urethral sling are the new gold standard therapy for female SUI. The long-term follow-up data are comparable to previous sling procedures. Transobturator mid-urethral slings are challenging to retropubic approach and under investigation. Increasing range of available procedures allows surgical treatment of SUI to be individualized for the patient. Although surgery will continue to play an important role in the treatment of SUI for women, highly qualified study are needed. Every urologist who wants to treat SUI patients has to understand physiology and pathophysiology of SUI and urodynamics, and be well trained even though new surgical techniques are easier than previous ones. That is because every surgery has its complications and surgeons have to deal them with the knowledge and experience. The field of SUI treatment is evolving continuously and undoubtfully current technique will be surpassed by newer, better concepts in the future.