Surgical management of urinary incontinence

Surgical treatment for urinary stress incontinence includes those corrective procedures for genuine stress incontinence (GSI), and these for severe forms of incontinence-including recurrent stress incontinence and intrinsic urethral sphincter deficiency (ISD). Patients with GSI and a mobile bladder neck should have a retropubic suspension procedure either by open or laparoscopic technique. Anterior repairs and needle procedures do not have long-term effectiveness. Patients with ISD and an mobile bladder neck may be treated with periurethral bulking with collagen. Patients with ISD and a mobile bladder neck, or those with recurrent GSI or a complicating issue such as asthma, should have a suburethral sling procedure.