What is A woman presents to the Gynecology outpatient department with a history suggestive of stress incontinence. Which of the following is the treatment of choice for genuine stress incontinence - and explain in detail?
Ans-D Tension Free Vaginal Taping (Ref. Shaw Gynecology 14th/pg. 175; TeLinde 9th/pg. 1052-1056; Novak's Gynecology 13th/pg. Chapter 20) Treatment of choice for genuine stress incontinence -Tension Free Vaginal Taping Gold standard treatment /Treatment with highest success rate is of Burch Colposuspension Operations for stress incontinence can be classified into four broad categories a. Traditional anterior vaginal colporrhaphy. b. Operations to correct stress incontinence resulting from anatomic hypermobility (retropubic bladder neck suspension operations, needle suspension procedures, tension-free vaginal tape, and some sling procedures). c. Operations for stress incontinence resulting from intrinsic sphincteric weakness or dysfunction (sling operations and periurethral injections). d. Salvage operations (intentionally obstructive sling operations, implantation of an artificial urinary sphincter, urinary diversion). Cure rates of different surical procedures for stress incontinence Operation Longterm cure (%) Kelly's repair Bladder buttress operation 67.8 MMK (Marshall-Marchetti-Krantz) operation 89.5 Burch colposuspension 89.8 Endoscopic suspension 86.7 Tension-free vaginal T-tape (TVT) 88-90 Vaginal sling operations 93.9 I. Sling Operations: a. After reviewing reports that included patient follow-up for more than 48 months, the American Urological Association and the Female Stress Urinary Incontinence Guidelines Panel concluded that the two most effective surgical treatments for stress incontinence are retropubic bladder neck suspensions and sling procedures. b. This panel confirmed that the use of sling operations in women with complex or recurrent stress urinary incontinence is a safe and effective treatment. II. Anterior Colporrhaphy Anterior vaginal repair is the oldest operation for stress incontinence in gynecology. It was described by Howard Kelly in 1914. He believed that stress incontinence was caused by an open vesical neck rather than from loss of urethral support, and he designed an operation to cure this condition by pulling the bladder neck closed using periurethral Kelly plication sutures. The problem with most techniques of anterior colporrhaphy is that they do not hold up well over time. Most surgical series that have evaluated techniques of anterior colporrhaphy for stress incontinence show long-term success rates of only 35% to 65%, a figure that most would regard as unacceptably low. Anterior colporrhaphy should be reserved primarily for patients requiring cystocele repair who do not have significant stress incontinence.