incontinence associated on coughing in association with urgency and demonstrable detrusor overactivity.

incontinence occurring in combination with detrusor overactivity.

incontinence occurring in the absence of urgency.

incontinence occurring on coughing in the absence of urgency and of urgency incontinence and with no demonstrable detrusor overactivity.

incontinence that is demonstrated during a cough on clinical examination.

is the most effective form of anti-incontinence surgery.

works by restoring the same mechanism of continence that was present before the onset of incontinence.

is carried out laparoscopically as effectively as via an open approach.

aims to improve the support to the urethrovesical junction and correct deficient urethral closure.

is an effective approach for primary intrinsic sphincter deficiency.

increasing age.

coexisting medical morbidity.

postoperative activity.

previous surgery.

obesity.

present only in 30% of patients presenting with SUI.

an absolute contraindication to a retropubic suspension procedure.

most likely present in the majority of women presenting with SUI.

accurately identified on the basis of Valsalva leak point pressure.

clearly defined in the current literature.

Strengthening the pubourethral ligaments

Re-creating the normal continence mechanism.

Suspending the bladder onto the periosteum of the symphysis pubis

Anchoring the obturator internus fascia to the iliopectineal line

Elevating the anterior vaginal wall and paravesical tissues toward the iliopectineal line

Using objective urodynamic-based outcome criteria

Improving symptoms from the patient’s perspective

Having follow-up data of at least 6 months’ duration

Identifying the degree of improvement in the urethral closure pressure

Achieving complete continence

A patient with inadequate vaginal length or mobility of the vaginal tissues

A patient with limited vaginal access

A patient who needs a concomitant hysterectomy that cannot be performed vaginally

A patient who frequently generates high intra-abdominal pressure due to a chronic cough

A patient with urethral descent with straining and SUI

It is important to avoid dissecting the old retropubic adhesions from prior incontinence procedures because these may contribute to continence.

It may be necessary to open the bladder to facilitate identification of the bladder margins and bladder neck.

Nonabsorbable sutures are better than absorbable sutures for retropubic suspension procedures.

A urethral Foley catheter is preferred for bladder drainage because it is more comfortable and associated with fewer urinary tract infections and earlier resumption of voiding.

The retropubic space must be drained after the procedure to prevent bleeding.

It is associated with osteitis pubis.

It carries little risk of causing urethral obstruction.

The sutures should incorporate a full thickness of the vaginal wall and lateral urethral wall.

It is important to elevate the midurethra and external sphincter in particular.

A better than 90% cure rate can be expected in the long term.

The repair is performed between the vagina and the arcus tendineus fasciae pelvis bilaterally.

It is less effective than a paravaginal repair.

It is appropriate only for patients with adequate vaginal mobility and capacity.

It is more effectively performed via a vaginal approach.

It is less effective than a tension-free vaginal tape procedure.

it is technically simple to perform.

it is more effective than an open colposuspension.

it is associated with shorter operating times.

it is associated with shorter hospitalization and recovery times.

it provides access for repair of an associated central defect cystocele.

detrusor sphincter dyssynergia.

postoperative voiding difficulty.

bladder denervation.

detrusor underactivity.

genitourinary tract fistulae.

should be managed by urethrolysis within 1 month.

occurs in less than 1% of patients.

is more likely if there is preexisting detrusor dysfunction.

may be due to detrusor sphincter dyssynergia.

is most likely to occur with undercorrection of the urethral axis.

DO is not causally related.

New-onset DO after a suspension procedure performed for stress urinary incontinence invariably resolves within 3 months.

DO occurs de novo, on average in less than 2% of the patients reported in the literature.

A history of voiding symptoms and new-onset storage symptoms as well as a retropubically angulated urethra usually suggests obstruction.

Preoperative DO is a contraindication to a retropubic suspension because it increases the risk of postoperative DO.

may aggravate posterior vaginal wall weakness, predisposing to enterocele.

results in genitourinary prolapse as a sequel to Burch colposuspension to occur in less than 10% of women.

occurs only rarely after a paravaginal repair.

will be prevented by a synchronous hysterectomy.

is rarely associated with a central defect cystocele.