[Surgical treatment possibilities of severe urinary incontinence in women]

Severe female urinary incontinence type 3 is a most difficult challenge to a urologic surgeon. In 40 of more than 800 patients evaluated for stress incontinence, type 3 urinary incontinence was diagnosed by clinical, urodynamic, and radiographic examination. The etiology was neurogenic or non-neurogenic. The first step of treatment in all patients was a modified pubovaginal sling to increase urethral resistance; this procedure was successful in 65%. Severely damaged periurethral tissues resulting from earlier multiple pelvic surgery (111 operations in 28 patients with non-neurogenic etiology), radiation, or prior local infections were responsible for failures. Patients whose incontinence was not corrected by this initial treatment required further surgical procedures, such as suburothelial Teflon injection, urethral reconstruction, and continent urinary diversion. This additional surgery resulted in an overall 92% success rate after a minimum follow-up of 18 months. In view of the severe nature of the incontinence of these individually problematic patients, this is a satisfactory results.