Surgery for urinary incontinence.

The surgical treatment for genuine stress incontinence will be dependent upon the presence or absence of previous surgery, the severity of the incontinence, the general medical fitness of the patient, and the expectations of the patient in a balance between efficacy and complications. No single operative procedure is the first-line treatment for all patients. A patient who is incontinent following surgery should not be assumed to have had failed surgery but should be appropriately investigated in order to exclude detrusor instability, fistula and chronic retention with overflow. Although the treatment of detrusor instability is primarily non-surgical, surgical options are available for selected patients in whom non-surgical treatment has failed. The management of vesico-vaginal fistulae is dependent upon an accurate assessment of the extent of the fistula and the absence of co-existing disease while success should be improved by centralizing surgical expertise.