AUA: Female SUI (2023): Difference between revisions

Line 273:

== Special cases ==

* '''~~The autologous PVS is the preferred surgical approach in patients with SUI and a fixed~~, immobile urethra (often referred to as ‘intrinsic sphincter deficiency’);''' RMUS or urethral bulking agents can be offered as alternatives

* '''Fixed, immobile urethra (often referred to as ‘intrinsic sphincter deficiency’)'''

* '''~~In patients undergoing concomitant~~ surgery for pelvic prolapse repair and SUI~~, physicians may perform any~~ of the incontinence procedures (e.g., midurethral sling, PVS, Burch colposuspension).'''

**'''Autologous PVS is the preferred surgical approach'''

** Must balance the benefits with the potential for an unnecessary surgery and possible additional morbidity

**RMUS or urethral bulking agents can be offered as alternatives

** A nomogram has been developed that can help estimate the risk of developing SUI after vaginal prolapse surgery and can aid in the decision regarding whether or not to perform a concomitant anti-incontinence procedure.

* '''Concomitant surgery for pelvic prolapse repair and SUI'''

* '''~~Physicians may offer patients with SUI and concomitant~~ neurologic disease affecting lower urinary tract function (neurogenic bladder) ~~surgical~~ treatment of SUI after appropriate evaluation and counseling have been performed~~'''~~.

**'''Any of the incontinence procedures (e.g., midurethral sling, PVS, Burch colposuspension) may be performed'''

** Patients with neurogenic lower urinary tract dysfunction do not fall into the category of the index patient, and a detailed evaluation should be performed. '''~~Other issues~~, such as incomplete emptying, detrusor overactivity, and impaired compliance, should be identified and in many cases treated prior to surgical intervention for SUI.'''

*** Must balance the benefits with the potential for an unnecessary surgery and possible additional morbidity

** '''In a patient who requires intermittent catheterization, one must be cognizant of possible complications with the use of a bulking agent (bulking effect may be attenuated by frequent catheter passage) or a synthetic sling (potential catheter trauma in the area of the sling could place the patient at risk for mesh erosion into the urethra).'''

*** A nomogram has been developed that can help estimate the risk of developing SUI after vaginal prolapse surgery and can aid in the decision regarding whether or not to perform a concomitant anti-incontinence procedure.

** '''Patients with neurogenic lower urinary tract dysfunction who undergo sling procedures in particular should be followed long-term for changes in lower urinary tract function that could be either induced over time by the neurologic condition itself, or potentially by the sling procedure.'''

* '''Concomitant neurologic disease affecting lower urinary tract function (neurogenic bladder)'''

*** '''New onset hydroureteronephrosis found after sphincter/sling placement in patients with a neurogenic bladder may be caused by bladder decompensation (detrusor noncompliance) that was not identified on pre-operative urodynamic studies'''

**'''Surgical treatment of SUI may be offered''' after appropriate evaluation and counseling have been performed.

*** Patients with neurogenic lower urinary tract dysfunction do not fall into the category of the index patient, and a detailed evaluation should be performed.

***'''Issues, such as incomplete emptying, detrusor overactivity, and impaired compliance, should be identified and in many cases treated prior to surgical intervention for SUI.'''

*** '''In a patient who requires intermittent catheterization, one must be cognizant of possible complications with the use of a bulking agent (bulking effect may be attenuated by frequent catheter passage) or a synthetic sling (potential catheter trauma in the area of the sling could place the patient at risk for mesh erosion into the urethra).'''

*** '''Patients with neurogenic lower urinary tract dysfunction who undergo sling procedures in particular should be followed long-term for changes in lower urinary tract function that could be either induced over time by the neurologic condition itself, or potentially by the sling procedure.'''

**** '''New onset hydroureteronephrosis found after sphincter/sling placement in patients with a neurogenic bladder may be caused by bladder decompensation (detrusor noncompliance) that was not identified on pre-operative urodynamic studies'''

* '''Synthetic MUS, in addition to other sling types, may be offered to the following patient populations after appropriate evaluation and counseling have been performed''':

** '''Patients planning to bear children'''

*# '''Patients planning to bear children'''

*** '''Placement of a sling should be postponed until child bearing is complete; among women with prior MUS, there is a high rate of SUI recurrence following delivery''', independent of mode of delivery

*#* '''Placement of a sling should be postponed until child bearing is complete; among women with prior MUS, there is a high rate of SUI recurrence following delivery''', independent of mode of delivery

** '''Diabetes'''

*# '''Diabetes'''

*** '''Higher risk for mesh erosion and reduced effectiveness''' compared with their non-diabetic counterparts.

*#* '''Higher risk for mesh erosion and reduced effectiveness''' compared with their non-diabetic counterparts.

** '''Obesity'''

*# '''Obesity'''

*** '''Worse clinical effectiveness of slings in obese patients compared with those with lower BMI.'''

*#* '''Worse clinical effectiveness of slings in obese patients compared with those with lower BMI.'''

** '''Geriatric (age >65)'''

*# '''Geriatric (age >65)'''

*** '''Lower likelihood of successful clinical outcomes compared with younger patients'''

*#* '''Lower likelihood of successful clinical outcomes compared with younger patients'''

== Outcomes assessment ==

@@ Line 273: / Line 273: @@
 == Special cases ==
-* '''The autologous PVS is the preferred surgical approach in patients with SUI and a fixed, immobile urethra (often referred to as ‘intrinsic sphincter deficiency’);''' RMUS or urethral bulking agents can be offered as alternatives
+* '''Fixed, immobile urethra (often referred to as ‘intrinsic sphincter deficiency’)'''
-* '''In patients undergoing concomitant surgery for pelvic prolapse repair and SUI, physicians may perform any of the incontinence procedures (e.g., midurethral sling, PVS, Burch colposuspension).'''
+**'''Autologous PVS is the preferred surgical approach'''
-** Must balance the benefits with the potential for an unnecessary surgery and possible additional morbidity
+**RMUS or urethral bulking agents can be offered as alternatives
-** A nomogram has been developed that can help estimate the risk of developing SUI after vaginal prolapse surgery and can aid in the decision regarding whether or not to perform a concomitant anti-incontinence procedure.
+* '''Concomitant surgery for pelvic prolapse repair and SUI'''
-* '''Physicians may offer patients with SUI and concomitant neurologic disease affecting lower urinary tract function (neurogenic bladder) surgical treatment of SUI after appropriate evaluation and counseling have been performed'''.
+**'''Any of the incontinence procedures (e.g., midurethral sling, PVS, Burch colposuspension) may be performed'''
-** Patients with neurogenic lower urinary tract dysfunction do not fall into the category of the index patient, and a detailed evaluation should be performed. '''Other issues, such as incomplete emptying, detrusor overactivity, and impaired compliance, should be identified and in many cases treated prior to surgical intervention for SUI.'''
+*** Must balance the benefits with the potential for an unnecessary surgery and possible additional morbidity
-** '''In a patient who requires intermittent catheterization, one must be cognizant of possible complications with the use of a bulking agent (bulking effect may be attenuated by frequent catheter passage) or a synthetic sling (potential catheter trauma in the area of the sling could place the patient at risk for mesh erosion into the urethra).'''
+*** A nomogram has been developed that can help estimate the risk of developing SUI after vaginal prolapse surgery and can aid in the decision regarding whether or not to perform a concomitant anti-incontinence procedure.
-** '''Patients with neurogenic lower urinary tract dysfunction who undergo sling procedures in particular should be followed long-term for changes in lower urinary tract function that could be either induced over time by the neurologic condition itself, or potentially by the sling procedure.'''
+* '''Concomitant neurologic disease affecting lower urinary tract function (neurogenic bladder)'''
-*** '''New onset hydroureteronephrosis found after sphincter/sling placement in patients with a neurogenic bladder may be caused by bladder decompensation (detrusor noncompliance) that was not identified on pre-operative urodynamic studies'''
+**'''Surgical treatment of SUI may be offered''' after appropriate evaluation and counseling have been performed.
+*** Patients with neurogenic lower urinary tract dysfunction do not fall into the category of the index patient, and a detailed evaluation should be performed.
+***'''Issues, such as incomplete emptying, detrusor overactivity, and impaired compliance, should be identified and in many cases treated prior to surgical intervention for SUI.'''
+*** '''In a patient who requires intermittent catheterization, one must be cognizant of possible complications with the use of a bulking agent (bulking effect may be attenuated by frequent catheter passage) or a synthetic sling (potential catheter trauma in the area of the sling could place the patient at risk for mesh erosion into the urethra).'''
+*** '''Patients with neurogenic lower urinary tract dysfunction who undergo sling procedures in particular should be followed long-term for changes in lower urinary tract function that could be either induced over time by the neurologic condition itself, or potentially by the sling procedure.'''
+**** '''New onset hydroureteronephrosis found after sphincter/sling placement in patients with a neurogenic bladder may be caused by bladder decompensation (detrusor noncompliance) that was not identified on pre-operative urodynamic studies'''
 * '''Synthetic MUS, in addition to other sling types, may be offered to the following patient populations after appropriate evaluation and counseling have been performed''':
-** '''Patients planning to bear children'''
+*# '''Patients planning to bear children'''
-*** '''Placement of a sling should be postponed until child bearing is complete; among women with prior MUS, there is a high rate of SUI recurrence following delivery''', independent of mode of delivery
+*#* '''Placement of a sling should be postponed until child bearing is complete; among women with prior MUS, there is a high rate of SUI recurrence following delivery''', independent of mode of delivery
-** '''Diabetes'''
+*# '''Diabetes'''
-*** '''Higher risk for mesh erosion and reduced effectiveness''' compared with their non-diabetic counterparts.
+*#* '''Higher risk for mesh erosion and reduced effectiveness''' compared with their non-diabetic counterparts.
-** '''Obesity'''
+*# '''Obesity'''
-*** '''Worse clinical effectiveness of slings in obese patients compared with those with lower BMI.'''
+*#* '''Worse clinical effectiveness of slings in obese patients compared with those with lower BMI.'''
-** '''Geriatric (age >65)'''
+*# '''Geriatric (age >65)'''
-*** '''Lower likelihood of successful clinical outcomes compared with younger patients'''
+*#* '''Lower likelihood of successful clinical outcomes compared with younger patients'''
 == Outcomes assessment ==