The treatment of moderate to severe anatomical stress urinary incontinence, SUI caused by internal urethral sphincter dysfunction and stress urinary incontinence that failed conservative treatment Surgical treatment of stress urinary incontinence has a history of more than 100 years in the world, and surgical treatment has been widely respected and used by scholars at home and abroad for its certain efficacy, fast results and obvious improvement in the quality of life of patients. There are nearly 200 types of SUI treatment. A, the urethral suspension belt surgery such as the use of synthetic medical materials, can be completed under local anesthesia + intravenous anesthesia, with certainty of efficacy, less invasive, short operation time, almost no bleeding and other advantages incomparable to other surgical procedures, such as the emergence of just over 10 years, has made the past 100 years nearly 200 kinds of treatment of female stress urinary incontinence procedures eclipsed. 1. Transvaginal tension-free vaginal tape (TVT) This procedure was invented in 1995 and was the first synthetic midurethral suspension. The inventors, Petros and Ulmsten, believed that the underlying cause of female stress urinary incontinence (SUI) was a defect in the pubourethral ligament, and therefore applied a polypropylene strip-like patch to the midurethra to reinforce the pubourethral ligament. The synthetic sling is made of polypropylene, approximately 1 cm wide and 40 cm long, and is attached to 2 stainless steel pins that are passed blindly through a vaginal incision at the level of the midurethra, through the posterior pubic space, and exit at a pre-cut incision in the pubic bone. This procedure has an internationally reported postoperative cure rate of 90%, an improvement rate of 5%-10%, and 5% ineffectiveness. It has been widely used in the early 21st century because of its short operative time, minimal trauma, and predictable outcome. However, this procedure has complications such as bladder perforation (incidence 0-25%), urethral injury, retropubic hematoma, and the need for intraoperative cystoscopic surveillance of the puncture needle alignment, which undoubtedly increases the operative time and cost. Therefore a variety of TVT improvement procedures have emerged in this century. 2.Tension-free obturator tap (TOT) was first reported by French surgeon Delorme in 2001. The sling is passed through the vascular nerve-free zone of the obturator membrane and the suspension mechanism is the same as that of TVT. The possibility of bladder perforation and vascular nerve injury is further reduced, and intraoperative cystoscopy can be eliminated, which further reduces the operation time, trauma and cost. The TOT strap simulates the anatomical structure of a “hammock” and is placed through a closed hole to re-establish suburethral support, which elevates the middle part of the urethra, increases urethral resistance, and restores control of urination. The purpose is to elevate the mid-urethra, increase urethral resistance, and restore control of urination. Compared with TVT, SPARC and IVS (Transvaginal Suspension), the sling is more in line with the natural anatomy of the pubic urethral ligament and is less likely to cause urethral obstruction and urinary retention after surgery. It has become the international gold standard for the treatment of female stress urinary incontinence. The cure rate of international TOT treatment for SUI is about 91%, and the improvement rate is 7.1%. Professor Fang Ping of the Second Affiliated Hospital of Tianjin Medical University is experienced in TOT surgery for female stress urinary incontinence, and the success rate of more than 200 cases of TOT surgery is nearly 100%, which is the leading level in China. 3.Tension-free vaginal tape-obturator (TVT-O) is basically the same as TOT, but the difference is that the direction of the puncture needle is from the vagina to the obturator. TVT-O puncture needle and sling 4. supraubic arch sling (SPARC) is basically the same as postpubic TVT, but the difference is that the path of the puncture needle in SPARC is “top-down”. This procedure has similar efficacy and postoperative complications as the postpubic TVT procedure, and is currently used significantly less than the TOT procedure. Second, the posterior pubic bladder urethral suspension (Burch surgery) through the open or laparoscopic completion, postoperative cure rate of about 90% a year, but with the widespread development of minimally invasive urethral sling surgery, such surgery because of the long operating time, postoperative complications, cure rate is not high defects as the first choice of treatment of female stress urinary incontinence. Third, paracervical filler injections Although they can reduce the symptoms of urinary incontinence in many women, they are unlikely to have a curative effect compared with surgery. Its efficacy decreases over time, and some studies have shown that most patients require additional treatment for an average of 1-2 years after receiving this treatment, so it is not used as a routine procedure to treat female stress urinary incontinence. Pelvic organ prolapse and pelvic floor reconstruction: Pelvic organ prolapse (POP): refers to the protrusion of the pelvic organs and their adjacent vaginal wall into or out of the vagina. The patient has pelvic pressure or swelling, altered sexual function, erosion of the prolapsed organ or tissue, and odor. There are symptoms such as stress incontinence, mixed incontinence, and urinary frequency and urgency. In severe cases of prolapse, patients can see the vaginal wall or cervix prolapsing from the external vaginal opening, which seriously affects the quality of life of patients and the relationship between husband and wife. Pelvic organ prolapse (POP) is an important female disease with a high prevalence. 50% of women who have undergone maternity have reported varying degrees of pelvic floor organ prolapse, but not all patients with prolapse have symptoms. Treatment of pelvic organ prolapse: I. Non-surgical treatment: for patients with mild to moderate prolapse 1. To relieve symptoms and also to reconstruct vaginal anatomy or improve sexual function, usually without serious side effects and complications. Surgery can be divided into three categories: 1. Reconstructive: application of the patient’s own tissue. 2. 2. compensatory: the use of artificial implants to fill the defect. 3. Closed: the vagina is closed or partially closed