incontinence occurring in combination with detrusor overactivity.
incontinence associated on coughing in association with urgency and demonstrable detrusor overactivity.
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.
incontinence occurring in the absence of urgency.
is an effective approach for primary intrinsic sphincter deficiency.
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.
is the most effective form of anti-incontinence surgery.
aims to improve the support to the urethrovesical junction and correct deficient urethral closure.
coexisting medical morbidity.
present only in 30% of patients presenting with SUI.
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.
an absolute contraindication to a retropubic suspension procedure.
Strengthening the pubourethral ligaments
Anchoring the obturator internus fascia to the iliopectineal line
Suspending the bladder onto the periosteum of the symphysis pubis
Re-creating the normal continence mechanism.
Elevating the anterior vaginal wall and paravesical tissues toward the iliopectineal line
Improving symptoms from the patient’s perspective
Achieving complete continence
Identifying the degree of improvement in the urethral closure pressure
Having follow-up data of at least 6 months’ duration
Using objective urodynamic-based outcome criteria
A patient with inadequate vaginal length or mobility of the vaginal tissues
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 limited vaginal access
A patient with urethral descent with straining and SUI
Nonabsorbable sutures are better than absorbable sutures for retropubic suspension procedures.
It may be necessary to open the bladder to facilitate identification of the bladder margins and bladder neck.
The retropubic space must be drained after the procedure to prevent bleeding.
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.
It is important to avoid dissecting the old retropubic adhesions from prior incontinence procedures because these may contribute to continence.
It is important to elevate the midurethra and external sphincter in particular.
It is associated with osteitis pubis.
The sutures should incorporate a full thickness of the vaginal wall and lateral urethral wall.
It carries little risk of causing urethral obstruction.
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 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 paravaginal repair.
It is less effective than a tension-free vaginal tape procedure.
it is associated with shorter hospitalization and recovery times.
it is associated with shorter operating times.
it provides access for repair of an associated central defect cystocele.
it is more effective than an open colposuspension.
it is technically simple to perform.
detrusor sphincter dyssynergia.
genitourinary tract fistulae.
postoperative voiding difficulty.
occurs in less than 1% of patients.
is most likely to occur with undercorrection of the urethral axis.
should be managed by urethrolysis within 1 month.
may be due to detrusor sphincter dyssynergia.
is more likely if there is preexisting detrusor dysfunction.
A history of voiding symptoms and new-onset storage symptoms as well as a retropubically angulated urethra usually suggests obstruction.
New-onset DO after a suspension procedure performed for stress urinary incontinence invariably resolves within 3 months.
DO is not causally related.
Preoperative DO is a contraindication to a retropubic suspension because it increases the risk of postoperative DO.
DO occurs de novo, on average in less than 2% of the patients reported in the literature.
will be prevented by a synchronous hysterectomy.
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.
is rarely associated with a central defect cystocele.
occurs only rarely after a paravaginal repair.
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