Updates to Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline (2023)

Abstract

Purpose: The purpose of this guideline is to provide a clinical structure with which to approach the diagnosis, counseling, and treatment of female patients with stress urinary incontinence (SUI). Materials/Methods: The primary source of evidence for the 2017 version of the SUI guideline was the systematic literature review conducted by the ECRI Institute. The initial search spanned literature from January 2005 to December 2015, with an additional updated abstract search through September 2016. The current amendment represents the first update to the 2017 iteration and includes updated literature published through February 2022. Results: This guideline has been amended to reflect changes in and additions to the literature since 2017. The Panel maintained that the differentiation between index and non-index patients remained important. The index patient is a healthy female with minimal or no prolapse who desires surgical therapy for treatment of pure SUI or stress-predominant mixed urinary incontinence. Non-index patients have factors that may affect their treatment options and outcomes, such as high grade prolapse (grade 3 or 4), urgency-predominant mixed incontinence, neurogenic lower urinary tract dysfunction, incomplete bladder emptying, dysfunctional voiding, SUI following anti-incontinence treatment, mesh complications, high body mass index, or advanced age. Conclusion: While gains have been made in the field to support new methods for the diagnosis, treatment, and follow-up of patients with SUI, the field continues to expand. As such, future reviews of this guideline will take place to stay in keeping with the highest levels of patient care.

Urethral Bulking With Polyacrylamide Hydrogel Compared With Other Treatments for Stress Urinary Incontinence

“…This is congruent with the American Urological Association's strong recommendation to offer bulking agents as an index surgical procedure for SUI. 7 As with every cost-effectiveness analysis, our conclusions are limited by the precision of each input variable. To mitigate this, we tested all key input variables with sensitivity analyses, which confirmed that our conclusions would not change.…”

Reconstruction of Urethral Sphincter With Polyacrylamide Hydrogel

“…5 Recently updated American Urological Association guidelines revised promoting MUS as first-line surgical treatment stating, "patients should be offered all viable options for treatment of their stress incontinence, with a discussion that includes detailed counseling regarding the risks, benefits, alternatives to each approach, and the safety and efficacy profiles of the various choices." 6 Because of the acceptable safety profile and negligible downtime, many patients prefer injectable therapies, despite inferior outcome data. 7 One study confirmed that many patients prefer a hierarchical approach to treatment.…”

Autologous platelet rich plasma (A‐PRP) combined with pelvic floor muscle training for the treatment of female stress urinary incontinence (SUI): A randomized control clinical trial

“…Additionally, energy-based treatments such as electromagnetic stimulation therapy and vaginal laser therapy, that is, fractional CO 2 , radiofrequency therapy, and ErYAG laser, have been investigated as treatment options for women with SUI; however, the guidelines and recommendations state that these methods cannot be considered standard treatments at this time and that more evidence of their efficacy is required. 4,5 Autologous platelet-rich plasma (A-PRP) is rapidly gaining popularity in the treatment of many diseases, particularly for promotion of wound healing and accelerating recovery. A-PRP is derived by density gradient centrifugation, which separates blood into distinct layers.…”

“…However, surgical management of SUI is associated with risks and complications, and bulking agents are relatively expensive and unavailable in some countries. Additionally, energy‐based treatments such as electromagnetic stimulation therapy and vaginal laser therapy, that is, fractional CO 2 , radiofrequency therapy, and ErYAG laser, have been investigated as treatment options for women with SUI; however, the guidelines and recommendations state that these methods cannot be considered standard treatments at this time and that more evidence of their efficacy is required 4,5 …”