الفهرس 
Anatomy Of The Female Lower Urinary Tract
Abdominal Leak-Point Pressure (Valsalva Leak-Point Pressure):Only 14 pages are availabe for public view
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Abstract
Female stress urinary incontinence is a common symptom, the prevalence of which varies between 5%-40% of the female population, according to the age group. Although conservative treatment for stress incontinence might give temporary relief definite cure require surgery.
Burch colposuspension is a well estsablished operation for correction of anatomic stress incontinence. But even in the hands of experienced surgeons, this operation is a major operation which is associated with post-operative morbidity, tendency for urinary retention, the need for catheterization, prolonged sick- leave and considerable costs. The striking need for less invasive, simple, and cheaper methods for correction of anatomic conditions causing stress incontinence has led to the development of several minimally invasive methods. Some of these methods fulfills the criteria of minimally invasiveness but cure rates and the duration of effectiveness have not always reached acceptable levels. This is true for the peri-urethral injections of different agencies and most needle suspension procedures. The introduction of the new integral theory by Petros and Ulmesten (1993) to explain stress incontinence according to which insentience is caused by impaired collagen function causing disruption of elements necessary to maintain anatomical structures involved in the closure mechanism of the urerthra. These elements are the pubo-urethral ligament, the vaginal insertion of pubococcygeal muscles and the vaginal support of the urethra. Based on this theory a new surgical procedure has been presented, first was the tension free vaginal tape (TVT) then the transobturator tape (TOT).
Although Tension free vaginal tape fulfill the cricteria of minimal invasive technique it carried the risk of complications as bladder injury, urethral injury, and retention, some are life threating as bowel injury. This has led to the introduction of a new technique that avoids the retropubic space, and depends on a tape passing through the obturator foramen away from the bladder and bowel in a relatively a vascular space away from important nerves and vessels, thus markedly decreasing the complications associated with the procedure.
The aim of this study was to to compare between Burch colposuspension and trans obturator tape (TOT) in the treatment of stress urinary incontinence as regard efficacy and rate of complications
Sixty women suffering from genuine stress urinary incontinence were divided into 2 equal groups similar in the demographic criteria, one group underwent the TOT technique , the other group underwent Burch colposuspension.
Patients of both groups were assessed preoperatively and postoperatively at 1 and 6 months.
Results showed that TOT is a quite safe and effective procedure with similar results to the gold standard operation (Burch colposuspension), however it has the advantage of being minimal invasive technique, is cost effective as regard hospital stay , operative time, rate of complications.
Conclude that in our series, the cure rates for of the TOT and Burch colposuspensions are similar but TOT is associated with less operative time and hospitalization day. TOT seems to be a better choice in the treatment of SUI;however, results of longer patient follow-ups are needed for more solid conclusions.