Stress incontinence Flashcards
1
Q
Management
A
- Conservative
o Lifestyle modification - Reduce fluid/caffeine/alcohol intake
- Stop smoking
- Weight loss
- Avoid triggers
- Bowel management
o Optimise medical comorbidities - Cease ACE-I if causing cough, diuretics
o Pelvic floor exercises - First line treatment
- 40% improve sufficiently to avoid surgery
- Should do under guidance of women’s physiotherapist
o Urethral support pessaries - Limited role
o Support with continence aids (ie pads) - Medical
o Vaginal oestrogen does not have significant benefit (unlike in urge)
Surgical
o Midurethral slings - Synthetic polypropylene tapes inserted to provide dynamic support to the urethra
- Concerns about mesh safety do not apply to MUS
- Preoperative urodynamic studies should be performed
- Cure rate 85-90% at 1 and 3 years, and 80% at 7 years
- Success rates for all procedures are lower in obese women
TVT-R vs TVT-o - Surgical
o Midurethral slings - Surgical consent
- Bleeding
- Damage to bladder, urethra, bowel, major vessels
- Postoperative voiding dysfunction including retention and need for IDC/ISC (2%) or loosening/removal of sling (1%)
- De novo urge incontinence or worsening of OAB symptoms 6%
- Pain and dyspareunia
- Groin pain (TOR only)
- Mesh erosion
- UTI
- Recurrence: 15% require further surgical treatment
- Single incision slings
- Many are being withdrawn from market
Burch colposuspension - Laparoscopic or open
- 85-90% success at 1 year, 75% at 5 years
- Higher risk de novo detrusor overactivity
o Bulking agents - Can be given under local anaesthesia so useful for elderly or unfit
- Reduced postoperative complications ie UTI, urge incontinence
- Risks: sterile abscess formation, tissue necrosis, migration of injected material, urethral prolapse
o Artificial sphincter – mostly studied in men
