Urologic surgical techniques.

Abstract

Surgery for incontinence, other than genuine stress incontinence, is a small part of the general gynecologist's practice. He or she must maintain a high index of suspicion for diverticula and fistulae. Included here are several good review articles that outline the state of the art and include classic references in the bibliography. Patients with cancer with a genitourinary fistula and incontinence may be managed in a variety of ways. Percutaneous nephrostomy and occlusion of the distal ureter may be an option in patients with incurable disease. Continent diversion, such as the Indiana pouch, offers a long-term remedy to the appropriate patient, even one who has been irradiated, as reported by Mannel. Iatrogenic incontinence is distressing to the patient and her doctor. Webster and Kreder offer keen insight into the evaluation of patients who have postoperative, obstructive, voiding dysfunction. They describe an operative correction, the obturation shelf repair, quite similar to the paravaginal defect repair, which restores "normal anatomy" and results in excellent relief of voiding dysfunction in approximately 90% of their patients. Postoperative bladder care is of concern to the doctor, patient, and nursing staff. Noble's article on the timing of catheter removal is innovative and practical.