[Operative therapy of urinary incontinence. Preoperative requirements--operation methods--after care]

Optimum success may be obtained from those incontinence operations which form one coherent unity with presurgical and postsurgical measures. Full elucidation of the symptom of urinary incontinence has proved to be the most important preoperative necessity. More comprehensive urometric objectivation will be required for problems which cannot be answered by a minimum programme. Time-consuming diagnosis should be, basically, accompanied by conservative incontinence treatment, primarily for three reasons, substantiation of diagnosis, avoidance of meaningless surgery, and improvement of conditions for the operation proper as well as for its lasting success. - The sling operation, retropubic urethrocystopexy, and vaginoplasty are major groups in stress incontinence surgery which are described by illustrated examples. Reference is made to partial denervation of the urinary bladder as a possible therapeutic approach to urge incontinence. Proposals are made for proper choice of methods, in agreement with both the general state of the art and the author's personal experience. - Postoperatively, particular attention should be given to continued physiotherapy, endurance of adequate micturition without residual urine, and nephrological follow-up care of patients with urinary tract infection who had failed to respond to therapy. The difficulties implied in identification of lasting results may be seen from the findings obtained from follow-up examination of patients on whom pubococcygeal repair had been performed. Something between four and five months will be required for optimum multi-step therapy.