Number №3, 2014 - page 80-87

Recurrent forms of urinary incontinence

Gvozdev M.Yu.

This article presents the results of the largest studies concerning to the causes and treatment strategy of recurrent forms of urinary incontinence. As it‘s shown, two reasons of urinary incontinence recurrence after implantation suburethral slings were highlighted – incorrect positioning of sling and the insufficient tension. Nowadays there are no clear guidelines for choosing the treatment tactics of recurrent form of urinary incontinence. A comprehensive examination this group of patients is actually needed, which includes gynecological examination with cough test, urethrocystoscopy and complex urodynamic investigation. In our opinion, patients with recurrent form of urinary incontinence should be operated by sling, but such surgery should be carried out not earlier than 3 months after the previous operation. According to the literature retropubic suburethral sling shows the highest efficiency in the treatment of recurrent stress urinary incontinence, which is possible because the retropubic sling is very similar to the anatomy of pubourethral ligaments than other types of slings. In case of insufficient compression of the previous sling, located at the middle of the urethra, it is necessary to perform a dissection. However, at the location of the loop in the proximal or distal urethra, its dissection is not obligatory. According to the reported data, results of treatment reoperated patients were worse than in the case of primary patients, and intraand postoperative complications occurred in a greater percentage of cases. Therefore, a crucial issue is the creation of training centers in Russian Federation, which allow to professionals to receive quality training and gain experience and knowledge from leading experts.

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