Surgical treatment of urinary incontinence in women.

Urinary incontinence affects many Americans, predominantly women. The majority of health care costs are spent on absorbent products, and diagnosis and treatment consume significant additional resources. Many factors interact with urinary incontinence-including medications, health conditions, and other pelvic floor disorders. There has been no meaningful research on prevention of urinary incontinence. The majority of research has focused on treatment, often with medical approaches or surgery. Surgery for urinary incontinence is largely limited to treatment of stress urinary incontinence. Nearly 300 procedures have been proposed, but very few have been the subject of significant, high-quality research. Three groups of surgical procedures (and their variants) have been utilized over the past decades: urethropexy, colposuspension, and the sling. Effective surgery appears to result from enhancing sphincteric closure during increases in intra-abdominal pressure. There are only a few studies that compare these procedures to one another. Many surgical procedures are adopted based on expert opinion and novel, untested concepts. A significant number of postoperative patients experience continued incontinence despite "cure" of stress incontinence. Research in the field of surgery for urinary incontinence can be facilitated by development of better diagnostic aids, better outcome measures, and techniques that allow standardization of interventions and testing procedures (including urodynamics). The role of industry needs close scrutiny-because novel, untested techniques and materials are frequently introduced without careful human subjects testing. Although surgery will continue to play an important role in the treatment of urinary incontinence for Americans, high-quality studies are urgently needed in this field.