Surgery for female SUI: The ICI algorithm

Abstract

Introduction Stress urinary incontinence (SUI) is common in women and can significantly impact quality of life. Methods This is a review of the 6th International Consultation on Incontinence (ICI) chapter analyzing level of evidence on surgical treatment of SUI as well as the consensus algorithm that resulted from the detailed work in the committee report as of April 2017. Included studies in this review were selected to highlight the algorithm for management. Results Non‐operative and surgical treatment options exist; conservative therapies comprise first line management, but if SUI remains bothersome, surgical treatment should be considered. Bulking agents offer a minimally invasive option with moderate short‐term success rates. The most commonly performed surgical treatments for SUI are mid‐urethral and pubovaginal slings, with high cure rates and patient satisfaction. Retropubic suspension is a more traditional but widely accepted procedure. Single incision sling, adjustable sling, or artificial urinary sphincter may be appropriate in carefully selected patients. Conclusions The choice of surgical procedure should be made only after a thorough discussion and shared decision between the patient and surgeon regarding risks, benefits, and alternatives. A trial of conservative therapy should be conducted where relevant. Referral to a specialist should be considered in women with a more complex presentation.

Urogynecology Section of the Polish Society of Gynecologists and Obstetricians guidelines on the management of stress urinary incontinence in women

“…Currently, sling implantation under the middle part of the urethra is based on the use of macroporous tape (type 1 according to Amid's Classification) [34][35][36][37]. The tape parameters allow to significantly reduce the risk of exposure as compared to multifilament and microporous materials (higher risk of infection).…”

Current Overview of Surgical Options for Female Stress Urinary Incontinence

“…Compared to other surgeries, bulking agents had higher objective recurrence rates but lower rates of voiding dysfunction [ 16 ]. Bulking agents may therefore be most appropriate for women who prefer a minimally invasive office procedure [ 17 ].…”

Risk Factors for 5-Year Complications after Midurethral Sling Surgery for Stress Urinary Incontinence: A Retrospective Cohort Study from Taiwan

“…[6][7][8][9][10] International guidance recommends conservative therapies as the first-line management of women with SUI, such as lifestyle changes and behavioral therapies, weight loss, and supervised pelvic floor muscle training. 11,12 For patients who do not experience improvement in physical symptoms and quality of life with nonsurgical management or pharmacotherapy, surgery is the next step. 11,12 The current gold standard for SUI surgery is the midurethral sling, with over 90% of surgeons worldwide using the midurethral sling for SUI between 2008 and 2018.…”