Stress Urinary Incontinence

Question 1

Describe your approach to a patient complaining of SUI symptoms.

Answer 1

History -clarify SUI vs UUI vs mixed sx
Pelvic exam: demonstrate urethral hypermobility, demonstrate SUI, latent SUI with reduction of prolapse, PVR
urinalysis and culture

Question 2

Name 3 non-surgical modalities shown to improve SUI sx:

Answer 2

1. supervised kegel’s with pelvic floor physio
2. bio-feedback (cones, functional electrical stimulation)
3. bladder drill (mainly for overactive bladder)
4. pessary

Question 3

What is the quoted success rate of a TVT procedure at 2 years?
How does this compare to a Burch procedure?

Answer 3

80% success rate at 2 years

equal to Burch but does not require open or even laparoscopic surgery

Question 4

What risks of TVT would you discuss with patient prior to procedure?

Answer 4

bleeding, infection, damage to bladder (perf) or vessels, hematoma, mesh erosion, de-novo urge symptoms