[Stress urinary incontinence in women. Physiopathology and surgical treatment using Burch's technique and TVT]

Abstract

FROM PHYSIOPATHOLOGY TO TREATMENT: Urinary incontinence on effort in women is due to a default in sub-urethral anatomical structure, which leads to incontinence on effort (coughing, laughing, carrying heavy weights, physical activity). When re-education fails, surgical treatment using Burch's technique or the placing of sub-urethral TVT (Tension free Vaginal Tape) is generally proposed. BURCH'S TECHNIQUE: Burch's technique consists in an upper tract colposuspension via coelioscopy or laparotomy, under rachis or general anaesthesia. In the literature, the following rates of complete cure have been presented: 64 to 87%, 75 to 95% and 63 to 89% respectively in the short, median and long term together with the cure of certain complications (vesicular instability, dysuria, secondary prolapse, infections). THE TVT TECHNIQUE: Developed in the early nineties, the placing of TVT is a mini-invasive technique requiring the use of polypropylene tape inserted vaginally under the urethra under rachis or local anaesthesia. It is associated with over 80% median term clinical efficacy and rare complications (vesicular perforation, arterial wounds, perineal haematoma, dysuria, infections).