Surgical treatment of stress urinary incontinence

The treatment of stress urinary incontinence (SUI) is one of mon controvers ial aspects of pelvic floor surgery. The indications for the surgical appro ach are related to the international classification as: Type 1 and Type 2 ( Anatomical Incontinence), and Type 3 urinary incontinence (Intrinsic Sphinc teric Dysfunction). The procedure of choice for Type 1 and Type 2 is Bladde r Neck Suspension (BNS) that create a strong hammock against which the uret hra can be compressed with sudden changes of abdominal pressure. Type 3 has to be treated by coaptation or compression of the deficient sphinteric uni t (slings or injections). The mean cure rate after Marshall-Marchetti-Krant z is 77%, that of the Burch is 81%, and that of the Needle Suspension is 79 %. Laparoscopy, Bone Anchors BNS and Tension-Free Vaginal Tape represent a promising option to the traditional techniques. The contribution of minimal invasive surgery consisting in: short recovery or possibility of day surge ry, reduced trauma and pain, and success rate similar to the conventional t echniques, is changing the SUI treatment. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.