Midurethral slings have become the gold standard in the surgical treatment of stress urinary incontinence (SUI). However, despite the high cure rates with these procedures, nearly 20% of the patients are incontinent after surgery. On the other hand, in a small percentage of women, voiding dysfunction may develop after surgery. Adjustable slings have been advocated in patients who fail an anti-incontinence surgery or have intrinsic sphincter deficiency (ISD) or in order to prevent postoperative voiding dysfunction. There are various options of adjustable slings according to the surgical route or the type of mesh used.
Part of the book: Synopsis in the Management of Urinary Incontinence
Chronic pelvic pain affects 2–24% of women in the reproductive period. There are various causes of chronic pelvic pain in women including gynecologic, urologic, gastrointestinal, and musculoskeletal problems. The treatment of pain is directed toward the underlying pathology. However, in some cases, no pathology can be found, and sometimes, more than one underlying pathology may be found in the same patient. Surgical denervation methods may be used in the treatment of chronic pelvic pain in women including uterosacral nerve ablation and presacral neurectomy. Uterosacral nerve ablation has been used as a treatment method for uterine causes of pelvic pain. It has been used widely in the treatment of dysmenorrhea- and endometriosis-related pain. But recent randomized studies and meta-analysis have questioned the effect of uterosacral nerve ablation in the treatment of chronic pelvic pain. Presacral neurectomy involves damage of the uterine sympathetic innervation at the level of superior hypogastric plexus. It is effective in the treatment of midline pelvic pain. It has been found to be more effective than laparoscopic uterosacral nerve ablation in a randomized study. The method, effect, and studies evaluating uterosacral nerve ablation and presacral neurectomy will be discussed in this chapter.
Part of the book: Chronic Pain