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7: The Treatment of Stress Incontinence

  • Page ID
    15611
    • 7.1: 7.1:Introduction
    • 7.2: 7.2-Where Do We Begin? – Physiotherapy
      The first step in therapy is to have the sufferer visit a physiotherapist with a special interest in pelvic floor rehabilitation. The physio will assess the strength of the patient’s pelvic floor, and suggest exercise to enhance the muscle power of the Levator muscles.
    • 7.3: 7.3-When Is Surgery Indicated?
    • 7.4: 7.4-The Surgical Management of Stress Incontinence
      Vaginal birth and aging are important causes of urinary stress incontinence. Ingenious operations to cure this common and distressing symptom in women have been devised. As a better understanding of the mechanisms of continence have evolved, 47 operations to cure the condition have improved.
    • 7.5: Historical Perspective
      Traditionally the anterior repair of a cystocoele using Kelly plication sutures have been useful in the management of stress incontinence. However the effect is transient, and while it cures anterior compartment prolapse, the anterior repair is not an authentic continence operation
    • 7.6: 7.6-The Retropubic TVT (TVT-R)
      Given that transobturator approaches are probably safer and equally as effective as retropubic TVT, the thoughtful continence practitioner must consider if the “inside – out” route is safer, or otherwise, than the “outside – in” transobturator approach.
    • 7.7: The New Transobturator Approach
      Transobturator “outside – in” procedures and transobturator “inside – out” procedures
    • 7.8: The Future
    • 7.9: Conclusion and References
      The obturator approach to the treatment of stress incontinence offers many advantages over previous operations, especially ease of surgery, safety and good predictable cure rates.

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