Surgical Therapy – Stress Urinary Incontinence
More than 300 operations have been described in medical literature for the treatment of stress urinary Incontinence since the early 1900’s. Unfortunately many of these operations, which are commonly performed throughout the world, have very poor surgical cure rates.
A common misnomer of surgical cure is the surgeon is performing a bladder tack operation. Actually the goal for most of these surgeries is to stop urinary leakage and this is accomplished by supporting the urethra and not the bladder. The urethra is the tube that allows urine to be expelled from the body. In an attempt to support the urethra, actually the vagina under and beside the urethra is the area which the operation takes place. The two most successful operations described and researched in the literature are: Pubovaginal Sling procedure and the Burch urethropexy (colposuspension) procedure. These two operations are commonly called the SLING and the BURCH procedures. Though some doctors may argue which is the better of the procedures, there are too many variables for this question to ever be answered scientifically. By narrowing the choice to these two operations the patient is getting one of the most successful operations described in the literature. Interestingly, the most common operation still performed in the United States is the anterior repair and/or Kelly plication.
Newer slings on the market since the late 1990’s are the TVT (tension free vaginal tape) slings and the TOT (transoburator tape) slings. On the average these slings are faster, easier, less traumatic, less painful with fewer complications than the older pubovaginal slings used for decades. The TVT was introduced into the USA in 1998 by Dr Miklos with the help of other surgeons such as Kohli MD, Lucente MD, Garely MD, Berger MD, Karram MD, and Klutke MD. In 2002 the TOT sling was introduced into the USA market by Dr Miklos’ partner, Dr Robert Moore. Both of these slings have 5 -10 year cure rates of 80-90% and are now considered the “GOLD STANDARD” in stress urine incontinence throughout the world today.
Surgical Cure Rates – Incontinence Operations
|ANTERIOR REPAIR||20-30%||5 YEARS|
|NEEDLE PROCEDURES |
|BURCH URETHROPEXY||80-90%||5-15 YEARS|
|PUBOVAGINAL SLINGS||80-90%||5-10 YEARS|
|TVT SLING||80-90%||5-10 YEARS|
|TOT SLING||80-90%||5-10 YEARS|
|MINI SLING||90%||1 YEAR|
Anterior Repair (colporrhaphy) and/or Kelly Plication
Anterior repair (colporrhaphy) has been used to treat stress incontinence in conjunction with a bladder and urethra drop (cystourethrocele) for years. Although anterior repair operation is commonly used for both incontinence and anterior vaginal wall relaxation, anterior repair is probably not the operation of choice for most patients. Anterior repair is a minimally invasive operation that is done through an incision in the anterior vaginal wall but only has a cure rate of 20-30% for stress urinary incontinence. The poor cure rate associated with the anterior repair is quite discouraging and often forces a patient to have a second surgery. Most urogynecologists or urologists would not recommend anterior repair operation, as their procedure of choice, for cure of stress urinary incontinence. Many surgeons who perform both sling (TVT, TOT, and Mini slings) and Burch procedures will choose the most appropriate operation based upon the individual patient's needs and urodynamic testing results.
For surgical treatment information of anterior repair, Click here.