Surgical correction

1. Surgery is used primarily in the treatment of stress urinary incontinence due to urethral hypermobility or intrinsic sphincter deficiency. Urethral hypermobility is corrected with retropubic urethropexy, transvaginal needle suspension, or a suburethral sling.

2. Retropubic urethropexy: vaginal tissue underneath the urethra is suspended to the pubic symphysis (Marshall-Marchetti-Krantz urethropexy) or Cooper's ligament (Burch colposuspension). The transvaginal needle suspension procedure is performed via the vaginal route with a small abdominal incision. The success rates for the retropubic urethropexy, transvaginal needle suspension, and suburethral sling are 80%, 70%, and 85%, respectively.

3. Intrinsic sphincter deficiency can be managed with a suburethral sling or periurethral collagen injections.

References: See page 195.

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