[Functional consequences and complications of surgery for female stress urinary incontinence]

The functional consequences and complications of surgical treatment offemale stress urinary incontinence (SUI) are not systematically reported in clinical trials. The authors present a practical review of the results of the surgical techniques most frequently used for the treatment of SUI.

An exhaustive literature search concerning the various surgical techniques for female SUI, their results, and their complications, was performed using MEDLINE (1966-2003) and the PUBMED search engine. Some papers presented by expert teams at international congresses were also included. In view of the diversity and weakness of the published results, a specific classification of the consequences of this surgery was adopted, comprising treatment failures, immediate (0 to 48 hours), early (before 6 weeks) and late (after 6 weeks) surgical complications, and impact on quality of life.

The best long-term success rate was observed for bladder neck slings. Prolene suburethral sling is a new promising technique, with an objective cure rate of more than 80%, but the publishedfollow-up does not exceed 3 years. Immediate complications included intraoperative bleeding, retropubic haematoma, urinary tract lesions, intestinal lesions, and complications related to the operative position. Early complications consisted of infections, pubic osteomyelitis, urinary fistula, sequelae of nerve lesions, and transient postoperative urinary retention. Late complications were induced voiding disorders, including dysuria, chronic urinary retention and detrusor instability, de novo genital prolapse, sexual disorders, chronic pain, chronic urinary tract infections and complications related to the use of biomaterials, including screws, synthetic tape, and artificial urinary sphincter. The quality of life after SUI surgery, although only rarely studied, was globally and constantly improved.

This review of the literature shows that no operation presents satisfactory results for all patients. Knowledge of the functional consequences and complications, although interesting, does not have any real value for the choice of a particular operation. Patient information implies mastery of all techniques and the choice of treatment must be determined case by case. This review provides a classified system of validated and detailed information, essentialfor the information of candidates for this functional surgery.