Surgery in urogynecology.

Abstract

Pelvic floor disorders, including stress urinary incontinence and pelvic organ prolapse, are common conditions that have a significant negative impact on the well-being and quality of life of women. Several surgical options exist for women who have failed conservative management of stress urinary incontinence and pelvic organ prolapse. The aim of this review is to outline the most common and current surgical procedures employed by urogynecologist for the treatment of these conditions and review their indications, success rates and common complications. Surgical options for stress urinary incontinence include retropubic colposuspension, slings, and urethral bulking injections. Midurethral slings are minimally invasive procedures with low rates of complications and good outcomes and as such have become the mainstay of surgical treatment for SUI. However, in patients for whom the risk of anesthesia and surgery is too high, urethral bulking injections may provide a safer alternative. A thorough understanding of the site of prolapse occurrence is necessary to provide the best surgical correction for women. There is growing recognition that correction of apical prolapse is important in decreasing the risk of prolapse recurrence. Apical prolapse can be repaired via vaginal or abdominal routes. Vaginal procedures include uterosacral ligament suspension, sacrospinous ligament suspension and obliterative procedures. Abdominal procedures include the abdominal sacrocolpopexy which can be performed by open laparotomy or with laparoscopic or robotic assistance. The use of mesh in vaginal prolapse repair is currently a heavily debated subject and more research is needed to establish its safety and efficacy. Urogynecologists are armed with a variety of surgical options for the treatment of pelvic floor disorders. The best surgery will always take into account the specific patient characteristics and her goals for surgery.