Editing Functional: Female SUI (section)

====== Outcomes ======
*'''Predominantly SUI'''
** '''<span style="color:#ff0000">Retropubic vs. Trans-obturator synthetic midurethral sling</span>'''
***'''Similar outcomes, regardless of urethral function'''
***'''Long-term comparisons are relatively lacking, however, data from increasing follow up appear to be demonstrating a <span style="color:#ff0000">lack of durability of Transobturator MUS, compared to Retropubic MUS</span>'''
** '''Single-Incision MUS in Patients with Predominantly SUI'''
*** There are fewer data available regarding the safety and efficacy of this new generation of slings compared with the retropubic and transobturator MUSs.
*** '''Single-incision slings have decreasing efficacy with longer follow-up.'''
* '''MUI'''
** '''Results with mixed incontinence are acceptable compared with other types of interventions for urinary incontinence but are less than those obtained in pure SUI.'''
* '''Intrinsic Sphincteric Deficiency'''
** '''The success of MUSs is lower in patients with ISD/fixed urethra (no urethral mobility) and low leak point pressures'''
*** '''Fixed urethras have poor outcomes after MUS surgery regardless of leak point pressure'''
*** '''Retropubic MUS are more effective than transobturator MUS in patients with ISD'''
** Low leak point pressures are not necessarily a contraindication to retropubic MUS surgery
** '''MUS is beneficial in the management of SUI in patients with ISD as long as there is preoperative urethral mobility; urethral mobility before MUS procedures has been shown to be predictive of success; the more the proximal urethra moves during a Valsalva maneuver, the better the cure rate for incontinence'''
* '''Efficacy and safety of MUSs are not compromised in those undergoing concomitant vaginal surgery, the elderly, or the obese.'''
**'''Pelvic Organ Prolapse'''
*** '''Results suggest that the MUS can be added to prolapse surgery with minimal morbidity.'''
**** The Cochrane Incontinence Group reviewed 22 randomized trials of surgical prolapse repair including 2368 women. They concluded that '''the addition of a retropubic MUS to endopelvic fascial plication, Burch colposuspension, and abdominal sacrocolpopexy may reduce the incidence of postoperative SUI''', but issues of cost and associated adverse effects were unclear
**** Women who underwent prolapse repair at the time of the sling surgery were significantly more likely to be diagnosed with postoperative outlet obstruction (9.4% vs. 5.5%, ''P'' < .007), but less likely to undergo a repeat procedure for stress incontinence or reoperation for prolapse within 1 year after sling surgery.
**** '''When MUSs are placed for urodynamic or occult SUI at time of prolapse repair, the risk of intervention because of obstruction is equivalent to the risk of intervention for SUI if no MUS was placed''' (8.5% and 8.3%, respectively)
*** MUSs placed with either transvaginal or laparoscopic-assisted vaginal hysterectomy and anterior or posterior colporrhaphy have been shown to have success rates similar to those in published series of MUS surgery alone. Complication rates are also in accordance with other MUS series
** '''Elderly Patients'''
*** '''Cure rates in older women with urethral hypermobility are comparable to those in younger women.'''
**** '''Elderly women should not be excluded from potentially curative MUS surgery based on their age alone.'''
**** Mixed urinary incontinence resolution rates are similar to those of the younger population
**** Possibly because of preoperative factors such as MUI or even decreased urethral hypermobility, '''the rate of persistent SUI after retropubic or transobturator MUS procedures appears higher in the elderly population'''.
*** Complication rates vary, with some studies citing a higher rate of age-related morbidities but '''no apparent increase in intraoperative complications.'''
**** '''Elderly patients experience higher rates of postoperative de novo urgency and urgency incontinence associated with any sling material, including MUS'''
**** Postoperative retention occurs to a similar degree as in younger patients
** '''Obese Patients'''
*** '''Controversial whether obesity affects surgical outcome with MUSs'''
*** Overall, the rate of complications appears to be similar in obese versus non-obese patients undergoing MUS surgery.
**** Higher rate of bladder trocar injury in non-obese patients
* '''Recurrent Stress Urinary Incontinence'''
** '''As salvage procedures, MUS have overall efficacy similar to their use in primary implantation procedures.'''
** '''The procedure can be performed in the same way as it is performed for primary SUI.'''
** '''The complication rate is similar to that of retropubic MUSs done for primary SUI, but the risk of bladder perforation appears to be higher''' in females who have had ≥1 prior retropubic suspensions.
** As is the case with primary surgery, the failure rate is higher in females with immobile urethras.
** '''No significant difference in subjective cure rates in patients after retropubic vs. transobturator MUS surgery for recurrent SUI.'''