Indications for Retropubic Procedures

Retropubic urethrovesical suspension procedures are indicated for women with the diagnosis of urodynamic stress incontinence and a hypermobile proximal urethra and bladder neck. These procedures yield the best results when the urethral sphincter is capable of maintaining a watertight seal at rest, but cannot withstand the unequal transmission of abdominal pressure to the proximal urethra, relative to the bladder, with straining. Although retropubic procedures can be used for intrinsic sphincter deficiency with urethral hypermobility, sling operations probably yield better long-term results.

Women with stress incontinence generally should have a trial of conservative therapy before corrective surgery is offered. Conservative treatments come in the form of pelvic muscle exercises, bladder retraining, pharmacologic therapy, functional electrical stimulation, and mechanical devices, such as pessaries. Eligible postmenopausal patients with atrophic urogenital changes should be prescribed vaginal estrogen before surgery is considered.

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