Female urinary incontinence. Therapeutic approaches.

Urinary incontinence results from bladder or sphincter dysfunction. Bladder-related incontinence due to a reduced-capacity, unstable, or noncompliant bladder can often be remedied by augmentation techniques. For anatomic incontinence, excellent results are achieved with use of any of the retropubic or transvaginal suspension techniques that restore the bladder neck and proximal urethra to a high, fixed retropubic position. However, when the urethral sphincter is intrinsically damaged, mere restoration of position will fail to cure the problem. Such damage warrants use of a compression procedure that increases urethral resistance, such as one of the many sling techniques, implantation of an artificial urinary sphincter, or periurethral Teflon injection.