Surgical Treatment of Female Stress Urinary Incontinence: AUA/SUFU Guideline

Aim The role of urodynamic study (UDS) in the management of female stress urinary incontinence (SUI) is one of the most controversial and debated topic in urogynecology. Here, we aimed to systematically assess the most relevant available evidence on urodynamics’ value in the management of women with stress urinary incontinence. Methods A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) Statement was performed in May 2018. Only randomized clinical trials, prospective studies, or retrospective studies articles evaluating the use of urodynamic studies in women with stress urinary incontinence were included. Results After screening a total of 3055 records, 39 studies published from 1996 to 2018 were included. Conclusions In an uncomplicated population of women with SUI, it is not demonstrated that preoperative urodynamic evaluation can improve the outcome of continence surgery; however, UDS provides additional information regarding lower urinary tract function that could guide the physician to make the right therapeutic choice. UDS should be considered mandatory before surgery in complicated patients, but its use should also be evaluated in index patients when the results may help counseling and management of these women.

Section: Resultsmentioning

confidence: 99%

The role of urodynamics in the management of female stress urinary incontinence

Serati¹,

Braga²,

Torella³

et al. 2019

“…Compared to the guidelines for the evaluation of SUI in women, the role of the physical examination in determining the degree of male SUI is underemphasized, and the definitions of mild and moderate SUI remain nebulous . The SCT, formalized from patterns of urinary leakage observed in our practice, represents an adjunctive measure with negligible expense, or time added to the preoperative visit.…”

Section: Discussionmentioning

confidence: 99%

Refined nomogram incorporating standing cough test improves prediction of male transobturator sling success

Shakir

Fuchs

McKibben

et al. 2018

“…When considering etiologies of stress incontinence, intrinsic sphincter deficiency may exist in isolation, or include a component of stress provoked detrusor overactivity. Common non‐surgical treatment options include incontinence liners/pads, pelvic floor muscle exercises, and anti‐incontinence pessaries . The clinical data regarding success specific to radiation induced bladder dysfunction for each of these is limited (Table ).…”

Section: Conservative Managementmentioning

confidence: 99%

Evaluation and treatment of female stress urinary incontinence after pelvic radiotherapy

Dobberfuhl

2018

Introduction Pelvic radiotherapy is associated with both acute and chronic voiding dysfunction. A review of the success and complications of surgical treatments for female stress urinary incontinence after pelvic radiotherapy has not been summarized in the published literature. Methods A systematic review of female stress urinary incontinence after pelvic radiotherapy was conducted using MeSH terminology (1988‐2018). Results There is limited published literature on the treatment of stress urinary incontinence in women following pelvic radiotherapy. Long term indwelling urethral catheter should be avoided in all women given the risk of iatrogenic hypospadias. Surgical treatments can be classified into those for the intact versus failed outlet. Urethral bulking injections have been studied in a prospective fashion specifically in women with stress urinary incontinence after radiotherapy and although not randomized, have the highest level of evidence. Patients should be screened for a history of prior radiotherapy before considering sling placement. Artificial urinary sphincter is associated with a high rate of erosion after prior radiotherapy. The role of Burch colposuspension in patients with prior radiotherapy is poorly defined. Urinary diversion should be considered for patients with a devastated outlet. Conclusions Since the long‐term effects of radiotherapy on lower urinary tract voiding function are typically irreversible and progressive, further research is needed to mitigate the adverse effects of irradiation and identify more durable treatment options for women with radiation induced bladder dysfunction and stress urinary incontinence.