Why Anti-Incontinence Surgery Succeeds or Fails

摘要

Defining success and failure in anti-incontinence surgery is becoming increasingly complex. Except in unusual cases, the impact of urinary incontinence is assessed by the degree of subjective bother to the patient. The amount, frequency, or volume of urinary incontinence is not necessarily related to the degree of bother and may be irrelevant to the patient. Large-volume urinary incontinence may be acceptable to some patients with the appropriate use of incontinence pads. Other women are socially incapacitated by losing a few drops of urine once per month. The amount of bother to the patient and not the amount of leakage is, in fact, what we treat with interventions for urinary incontinence.Success or failure in the treatment of urinary incontinence is tied to the patient's perception of success or failure and may differ from the surgeon's perception. New onset urgency and any unpredictable urgency incontinence may, in fact, be considered failure to the patient, despite the cure of "stress" incontinence.In the medical literature, success is defined by the surgeons (or authors). These definitions are variable and subject to bias. Recent reports showing differences between surgeon- and patient-defined success have refocused the evaluation of therapy for stress urinary incontinence (SUI).1,2Success or failure in anti-incontinence surgery are increasingly being measured with quality of life questionnaires and outcome evaluations, which are strongly tied to patient satisfaction.The surgical objective for stress incontinence procedures is to create sufficient outlet resistance to prevent urine loss until a socially acceptable time and place. Unsuccessful surgeries fail to do this. Failure includes persistent SUI, de novo or worsened urge incontinence, obstructive or irritative voiding symptoms, urinary retention, and postoperative pelvic prolapse or surgical complications such as bleeding, fistula, infection, and/or dyspareunia. We will discuss the mechanisms for urinary continence and incontinence, describe a successful anti-incontinence operation, and finally discuss the etiologies of failed anti-incontinence surgery.