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  • Many are being withdrawn from market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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly