[Treatment of urinary incontinence in women and the role of physiotherapy].

Physiotherapy including pelvic floor muscle exercises, vaginal cones, biofeedback or electrical stimulation can be recommended as first step therapy for genuine stress incontinence. However physiotherapy has its limitations: 30% of women do not improve at all and only 10 to 20% of women are totally dry after treatment. In case of failure or insufficient response, surgery must be considered. Until recently, the gold standard for the treatment of urinary incontinence was the "Burch" procedure. However the surgical approach has been considerably modified since the introduction by Ulmsten in 1995 of the tension-free vaginal tape (TVT) and more recently of the "Uratape". Short and mid-term results of the TVT are very encouraging with about 85% "dry patients" at five years follow-up. This technique can also be used with good results in patients with a low urethral pressure (< 20 cm H2O). Of course the superiority of TVT over other "classical techniques" must be confirmed by randomized comparative studies.