AUA: Female SUI (2023): Difference between revisions
Urology4all (talk | contribs) |
Urology4all (talk | contribs) |
||
| Line 234: | Line 234: | ||
====== Autologous fascia pubovaginal sling ====== | ====== Autologous fascia pubovaginal sling ====== | ||
* '''Procedure more morbid than | * '''<span style="color:#ff0000">Procedure more morbid than MU</span>S''' | ||
* '''Adverse events:''' | * '''<span style="color:#ff0000">Adverse events:</span>''' | ||
*#'''Wound infection''' | *#'''<span style="color:#ff0000">Wound infection</span>''' | ||
*#'''Seroma formation''' | *#'''<span style="color:#ff0000">Seroma formation</span>''' | ||
*#'''Ventral incisional or leg hernia depending on the fascial harvest site''' | *#'''<span style="color:#ff0000">Ventral incisional or leg hernia depending on the fascial harvest site</span>''' | ||
====== Burch colposuspension ====== | ====== Burch colposuspension ====== | ||
* '''Indications''' | * '''<span style="color:#ff0000">Indications</span>''' | ||
*#'''Patient preference to avoid mesh and avoid the morbidity of fascial harvest''' | *#'''<span style="color:#ff0000">Patient preference to avoid mesh and avoid the morbidity of fascial harvest</span>''' | ||
*# '''Undergoing a simultaneous abdominal procedure, such as open or minimally invasive hysterectomy''' | *# '''<span style="color:#ff0000">Undergoing a simultaneous abdominal procedure, such as open or minimally invasive hysterectomy</span>''' | ||
===== Risks of surgical intervention ===== | ===== Risks of surgical intervention ===== | ||
* '''Intra-operative risks: risks of anesthesia, bleeding, UTI, bladder injury, and urethral injury, and procedure-specific risks (see below)''' | * '''<span style="color:#ff0000">Intra-operative risks: risks of anesthesia, bleeding, UTI, bladder injury, and urethral injury, and procedure-specific risks (see below)</span>''' | ||
* '''Post-operative (4):''' | * '''<span style="color:#ff0000">Post-operative (4):</span>''' | ||
*# '''Voiding dysfunction''' | *# '''<span style="color:#ff0000">Voiding dysfunction</span>''' | ||
*#* '''May involve both storage and emptying symptoms''' | *#* '''May involve both storage and emptying symptoms''' | ||
*#* '''Risk of de novo or worsening of baseline storage symptoms for patients with MUI or SUI with urinary urgency.''' | *#* '''Risk of de novo or worsening of baseline storage symptoms for patients with MUI or SUI with urinary urgency.''' | ||
*#* '''Management''' | *#* '''Management''' | ||
*#** '''Appropriate and effective to initially treat persistent voiding dysfunction conservatively.''' This includes temporary catheter drainage, CIC, timed voiding, double voiding, biofeedback, pelvic floor muscle training, and anticholinergic therapy. | *#** '''Appropriate and effective to initially treat persistent voiding dysfunction conservatively.''' This includes temporary catheter drainage, CIC, timed voiding, double voiding, biofeedback, pelvic floor muscle training, and anticholinergic therapy. | ||
*# '''Obstruction resulting in urinary retention''' | *# '''<span style="color:#ff0000">Obstruction resulting in urinary retention</span>''' | ||
*#* '''Management''' | *#* '''Management''' | ||
*#** '''Would require intermittent catheterization, indwelling Foley catheter drainage, and possible sling incision, sling loosening, or urethrolysis if this does not resolve spontaneously''' | *#** '''Would require intermittent catheterization, indwelling Foley catheter drainage, and possible sling incision, sling loosening, or urethrolysis if this does not resolve spontaneously''' | ||
| Line 263: | Line 263: | ||
*#*** '''Urinary obstruction after MUS surgery is usually transient and can be managed with short-term intermittent catheterization''', although occasionally symptoms mandate sling release. | *#*** '''Urinary obstruction after MUS surgery is usually transient and can be managed with short-term intermittent catheterization''', although occasionally symptoms mandate sling release. | ||
*#*** '''For patients with persistently elevated residual urine and bothersome symptoms refractory to conservative management, transvaginal sling release procedures consistently provide resolution of symptoms with maintenance of continence in the majority of patients. We recommend a waiting period of at least 2 to 4 weeks before sling release.''' | *#*** '''For patients with persistently elevated residual urine and bothersome symptoms refractory to conservative management, transvaginal sling release procedures consistently provide resolution of symptoms with maintenance of continence in the majority of patients. We recommend a waiting period of at least 2 to 4 weeks before sling release.''' | ||
*# '''Pain with sexual activity''' | *# '''<span style="color:#ff0000">Pain with sexual activity</span>''' | ||
*# '''Persistent SUI''' immediately after the procedure or recurrent SUI at a later time that may require further intervention | *# '''<span style="color:#ff0000">Persistent SUI</span>''' immediately after the procedure or recurrent SUI at a later time that may require further intervention | ||
== Special cases == | == Special cases == | ||