20 Diagnosis High index of suspicion: post-vaginal / urethral surgery synthetic slingdifficult childbirthpelvic fractureVaginal examination:witness urine loss from urethraOcclude meatus with finger during coughLook for urine loss proximal to meatusCystoscopy
21 Preoperative Considerations Accurate diagnosis – SUI vs fistulaRecognize associated abnormalitiesSphincteric incontinenceUrethral diverticulumPeriurethral abscessVesicovaginal fistulaAccessibility of local tissue for flapTiming of surgery
22 Intra-operative Considerations Choice of procedure (usually decided intraop)Assess adequacy of local tissueAdequate operative exposure
85 Conclusions Vaginal repair is possible in almost all patients Most patients with pre-op SUI should have synchronous anti-incontinence op +/- Martius flapSuccessful outcome is achievable in over 85% of patients
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