الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 32 |  |  |
| | | from | 32 | | |
Abstract
Every patient with urinary stress incontinence deserves a careful evaluation. The initial surgery to treat stress urinary incontinence should be performed with meticulous care by a competent surgeon who will continue the same care following surgery. Statistically the best chance of cure is with the first operation.
A patient with recurrent urinary stress incontinence requires even more careful evaluation and qualified care. The quality of the local support tissues should receive serious consideration. If the local tissues are weak, another primary procedure is doomed to failure. Too often the gynecologist mechanistically follows an anterior colporrhaphy with a ventral suspension or vice versa without asking, “Is this support tissue really reparable’?” Lack of though in this regard may be due to an egotistic belief that one can cure where others have failed, or to a slavish adherence to routine and ritual.
If careful consideration indicates that the local support tissue is irreparably poor, sling can provide an ideal tissue graft. Because of the extended operating time and the postoperative problems, a sling operation should not be performed as a primary procedure unless it can be predicted that a well done standard primary procedure will not withstand the stress of violent increase in intra-abdominal pressure, such as may occur with coughing in a patient with sever asthmatic bronchitis.
The use of the suburethral sling procedure mandates not only a choice of suture material but also a choice of sling material, as well. The use of endogenous tissue including fascia lata, rectus fascia, and round ligaments, is commonplace. The major drawback of this option is the harvesting of a sufficient quantity of sling material and guaranteeing the quality of the material. In particular, obtaining fascia lata involves a