Surgical treatment for female stress urinary incontinence across various anatomical regions

Adam Ostrzenski, M.D., Ph.D., Dr. Habil.
Professor of Gynecology
Florida International University, Miami, Florida, USA

Abstract

Introduction: In October 2008, the FDA issued a Public Health Notification about severe complications and insufficient information suggesting that mesh-sling surgery improves clinical outcomes compared to traditional non-mesh treatments. Additionally, medical societies have raised concerns that surgical meshes and slings are linked to low but serious complications, including death, when treating stress urinary incontinence in women, and their long-term effectiveness remains uncertain. However, no recommendations were made to replace the currently used slings and meshes for treating female stress incontinence. Numerous clinical-scientific studies have shown that the native tissue of the female pelvis has considerable strength and durability. Therefore, using native tissue is suitable for surgical treatment; however, transitioning from slings and meshes to reconstruction with native tissue requires a comprehensive understanding of anatomy in various regions. With significant advancements in dynamic magnetic resonance imaging and ultrasonography, accurate identification of site-specific defects across multiple anatomical regions is now possible, allowing for targeted reconstruction.

Methods: A systematic review addressed the question, “Which anatomical regions contain the structures that support female urinary continence?" A PowerPoint presentation will summarize the findings.

Results: This systematic review documents the anatomy of female urinary continence across various anatomical regions for the first time. It also updates evidence-based medical data and emphasizes the importance of a thorough anatomical understanding when transitioning from meshes and slings to native tissue for treating urinary incontinence in women.
Furthermore, the pelvic floor muscles, endopelvic fascia, perineal membrane, and anterior-distal vaginal wall help maintain the urethra's natural position.

Conclusions: Identifying site-specific defects in various anatomical regions and repairing them with native tissue may help prevent surgical treatment failures in female stress incontinence.