Advertisement

Management of Stress Urinary Incontinence

  • Aswini Balachandran
  • Jonathan Duckett
Chapter

Abstract

Stress urinary incontinence is a common debilitating condition affecting millions of women worldwide. Conservative treatments are recommended as first-line therapies, but many women need surgical treatment if pelvic floor muscle training is ineffective. In the past the colposuspension operation was the gold standard, but over the last 15 years, this technique has been replaced by mid-urethral sling procedures. These have a high success rate and reduced morbidity. The original retropubic (down-up) sling has been modified and now transobturator slings (inside-out and outside-in) are also available. Recently, short single-incision slings (mini-slings) have been introduced, although current evidence suggests an inferior outcome. We are still learning the benefits and limitations of each type of sling, and many surgeons express a keen preference for one sling over another. Different surgeons obtain very different results with similar slings. As surgeons we should aim to audit our results so that we ensure we give our patients the best possible outcome. This article reviews the current surgical treatment options for stress urinary incontinence.

Keywords

Stress Urinary Incontinence Detrusor Overactivity Pelvic Floor Muscle Training Artificial Urinary Sphincter Pubovaginal Sling 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J Pelvic Floor Dysfunct. 2010;21:5–26.CrossRefGoogle Scholar
  2. 2.
    Harding C, Thorpe A. Surgical treatment for stress urinary incontinence. Int J Urol. 2008;15:27–34.PubMedCrossRefGoogle Scholar
  3. 3.
    Hunskaar S, Lose G, Sykes D, Voss S. The prevalence of urinary incontinence in women in four European countries. BJU Int. 2004;93:324–30.PubMedCrossRefGoogle Scholar
  4. 4.
    Chong EC, Khan AA, Anger JT. The financial burden of stress urinary incontinence among women in the United States. Curr Urol Rep. 2011;12:358–62.PubMedCrossRefGoogle Scholar
  5. 5.
    Dillon B, Zimmern P. When are urodynamics indicated in patients with stress urinary incontinence? Curr Urol Rep. 2012;13(5):379–84.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Nager CW, Brubaker L, Litman H, et al. A randomized trial of urodynamic testing before stress-incontinence surgery. N Eng J Med. 2012;366:1987–97.CrossRefGoogle Scholar
  7. 7.
    Weatherall M. Biofeedback or pelvic floor muscle exercises for female genuine stress incontinence: a meta-analysis of trials identified in a systematic review. BJU Int. 1999;83:1015–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2014;(5):CD005654.Google Scholar
  9. 9.
    Labrie J, Bergmans BLCM, Fischer K, et al. Surgery versus physiotherapy for stress urinary incontinence. N Engl J Med. 2013;369:1124–33.PubMedCrossRefGoogle Scholar
  10. 10.
    Basu M, Duckett J. Update if duloxetine for the management of stress urinary incontinence. Clin Interv Aging. 2009;4:25–30.PubMedCentralPubMedGoogle Scholar
  11. 11.
    Mariappan P, Alhasso A, Ballantyne Z, Grant A, N’Dow J. Duloxetine a serotonin and noradrenaline reuptake inhibitor (SNRI) for the treatment of stress urinary incontinence; a systematic review. Eur Urol. 2007;51:67–74.PubMedCrossRefGoogle Scholar
  12. 12.
    Ghoniem GM, Van Leeuwen JS, Elser DM, et al. A randomized controlled trial of duloxetine alone, pelvic floor muscle training alone, combination treatment and no active treatment in women with stress urinary incontinence. J Urol. 2005;173:1647–53.PubMedCrossRefGoogle Scholar
  13. 13.
    Vella M, Duckett J, Basu M. Duloxetine 1 year on: the long term outcome of a cohort of women prescribed duloxetine. Int Urogynecol J. 2008;19(7):961–4.Google Scholar
  14. 14.
    Duckett JR, Vella M, Kavalakuntla G, Basu M. Tolerability and efficacy of duloxetine in a non trial situation. BJOG. 2007;114:543–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Novara G, Artibani W, Barber M, et al. Updated systematic review and meta-analysis of the comparative data of colposuspensions, pubovaginal slings and midurethral tapes in the surgical treatment of female stress urinary incontinence. Eur Urol. 2010;58:218–38.PubMedCrossRefGoogle Scholar
  16. 16.
    Alcalay M, Monga A, Stanton SL. Burch colposuspension: a 10–20 year follow up. Br J Obstet Gynaecol. 1995;102:740–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Rovner E, Wein A. Treatment option for stress urinary incontinence. Rev Urol. 2004;6 Suppl 3:29–47.Google Scholar
  18. 18.
    Vancaille T, Schuessler W. Laparoscopic bladder neck suspension. J Lap Endo Surg. 1991;1:169–73.CrossRefGoogle Scholar
  19. 19.
    Dean N, Herbison P, Ellis G. Laparoscopic colposuspension and tension-free vaginal tape: a systematic review. BJOG. 2006;113:1345–53.PubMedCrossRefGoogle Scholar
  20. 20.
    Norton P, Brubaker L. Urinary incontinence in women. Lancet. 2006;367:57–67.PubMedCrossRefGoogle Scholar
  21. 21.
    Doo CK, Hong B, Chung BJ, et al. Five year outcomes of the tension-free vaginal tape procedure for treatment of female stress urinary incontinence. Eur Urol. 2006;50:333–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Ward K, Hilton P, UK and Ireland TVT Trial Group. Tension free vaginal tape versus colposuspension for primary urodynamic stress incontinence: 5 year follow-up. BJOG. 2008;115:226–33.PubMedCrossRefGoogle Scholar
  23. 23.
    Nilsson C, Palva K, Rezapour M, et al. Eleven years prospective follow-up of the tension-free vaginal tape procedure for treatment of stress urinary incontinence. Int Urogynaecol J. 2008;19:1043–7.CrossRefGoogle Scholar
  24. 24.
    Serati M, Ghezzi F, Cattoni E, et al. Tension-free vaginal tape for the treatment of urodynamic stress incontinence: efficacy and adverse effects at 10 year follow-up. Eur Urol. 2012;61:939–46.PubMedCrossRefGoogle Scholar
  25. 25.
    Nilsson CG, Palva K, Aarnio R, Morcos E, Falconer C. Seventeen years’ follow-up of the tension free vaginal tape procedure for female urinary stress incontinence. Int Urogynecol J. 2013;24:1265–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Latthe PM, Singh P, Foon R, Toozs-Hobson P. Two routes of transobturator tape procedures in stress urinary incontinence: a meta-analysis with direct and indirect comparison of randomized trials. BJU Int. 2010;106:68–75.PubMedCrossRefGoogle Scholar
  27. 27.
    Dyrkom OA, Kulseng-Hanssen S, Sandvik L. TVT compared with TVT-O and TOT: results from the Norwegian National Incontinence Registry. Int Urogynecol J. 2010;21:1321–6.CrossRefGoogle Scholar
  28. 28.
    North CE, Hilton P, Ali-Ross NS, Smith AR. A 2-year observational study to determine the efficacy of a novel single incision sling procedure (Minitape) for female stress urinary incontinence. BJOG. 2010;117(3):356–60.PubMedCrossRefGoogle Scholar
  29. 29.
    Mostafa A, Agur W, Abdel-All M, Guerrero K, Lim C, Allam M, Yousef M, et al. Multicenter prospective randomized study of single-incision mini-sling vs tension-free vaginal tape-obturator in management of female stress urinary incontinence: a minimum of 1-year follow-up. Urology. 2013;82(3):552–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Basu M, Duckett J. A randomised trial of a retropubic tension-free vaginal tape versus a mini-sling for stress incontinence. BJOG. 2010;117:730–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Abdel-Fattah M, Ford JA, Lim CP, Madhuvrata P. Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence: a meta-analysis of effectiveness and complications. Eur Urol. 2011;60(3):468–80.PubMedCrossRefGoogle Scholar
  32. 32.
    Webster GD, Perez LM, et al. Management of type III stress urinary incontinence using artificial urinary sphincter. Urology. 1992;39(6):499–503.Google Scholar
  33. 33.
    Pickard R, Reaper J, Wyness L. Periurethral injection therapy for urinary incontinence in women. Cochrane Database Syst Rev. 2003;(2):CD003881.Google Scholar
  34. 34.
    Noblett K, Markle D, Skoczylas L. Management of urinary incontinence and retention. In: Benson JT, editor. Atlas of female pelvic medicine and reconstructive surgery. 2nd ed. Philadelphia, USA: Springer; 2009.Google Scholar

Copyright information

© Springer India 2015

Authors and Affiliations

  1. 1.Department Obstetrics and GynaecologyMedway HospitalGillingham, KentUK

Personalised recommendations