Surgery for urinary incontinence

The surgical treatment for genuine stress incontinence will be dependent up on the presence or absence of previous surgery, the severity of the inconti nence, the general medical fitness of the patient, and the expectations of the patient in a balance between efficacy and complications. No single oper ative procedure is the first-line treatment for all patients. A patient who is incontinent following surgery should not be assumed to have had failed surgery but should be appropriately investigated in order to exclude detrus or instability, fistula and chronic retention with overflow. Although the t reatment of detrusor instability is primarily nonsurgical, surgical options are available for selected patients in whom non-surgical treatment has fai led. The management of vesico-vaginal fistulae is dependent upon an accurat e assessment of the extent of the fistula and the absence of co-existing di sease while success should be improved by centralizing surgical expertise.