Choice of operation for genuine stress incontinence.

Surgery, the definitive treatment for most patients with genuine stress urinary incontinence, continues to evolve, as does the rationale for choice and application of given operations. The history of surgical progress to the present is well covered by Kohorn (Obstet Gynecol Clin North Am 1989, 16:841-852) and includes those operations that have progressively supplanted the anterior colporrhaphy on which the gynecologist traditionally depended. Emphasis on the secure retropubic placement of the bladder neck has led to the development of a number of modifications of open retropubic cystourethropexy, minimal incision needle suspension techniques, and various sling operations; recently reported modifications are acknowledged. The rationale of curing incontinence by restoring normal anatomy in the course of identifying and repairing discrete fascial defects has led to increased acceptance and use of the paravaginal or obturator shelf repair.