ABSTRACT
Proper evaluation with a thorough physical exam and urodynamic assessment is the first step in approaching patients with stress incontinence. There are several procedures that have been used to treat these patients once nonsurgical management of their symptoms has failed. Surgical treatment of stress urinary incontinence can be approached abdominally, vaginally, transurethrally, or laparascopically. Assuming that the goal of treatment is not to trade incontinence with continence caused by total urethral outlet obstruction, the surgeon must tailor the operative approach for each individual patient. If the patient is continent at rest (sitting or lying down), the ideal treatment will be to simulate this situation while the patient is active (walking, coughing, sneezing, etc.). Transabdominal procedures can achieve this by stabilizing the anterior vaginal wall and, especially, the tissue next to and around the urethra. Starting with the Kelly plication, this chapter follows the evolution from the Marshall-Marchetti-Kranz (MMK) to the Burch procedure, along with some of its common modifications, and ends with a description of the paravaginal repair.
