Female Stress Urinary Incontinence

Who has Stress Incontinence?

Workup

History

Physical

Adjuncts

Definitely needs further workup if...

Unclear diagnosis, unable to demonstrate SUI, concern for neurogenic LUTS, abnormal UA (hematuria/pyuria), urge predominant MUI, elevated PVR, high grade PVR (3-4), significant voiding dysfunction

May need further workup if...

OAB symptoms, prior failed surgery, prior prolapse surgery

Obtional Adjuncts:

Nonsurgical options

Surgical Options

Midurethral Sling

Pubovaginal sling

Burch Colposuspension

Intraurethral bulking agents

Non-Index Patients

Risks/Complications

General Risks

Retropubic sling

Transobturator sling

Pubovaginal Sling

Burch Colposuspension

Bulking Agents

Jelovsek, J. Eric, et al. "A model for predicting the risk of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery." Obstetrics and gynecology 123.2 0 1 (2014): 279.

Important Stress Incontinence Studies

CARE (Brubaker 2008): colposuspension at time of sacrocolpopexy leads to less postoperative SUI (without preoperative SUI)

OPUS (Wei 2009): anterior vaginal wall prolapse repair, postoperative SUI rates 27% if retropubic MUS performed (vs 43% for sham procedure), NNT 6.3 to see benefit of adding MUS

TOMUS (Kobashi 2017): at 5yrs, minimal difference in success between retropubic and transobturator midurethral slings

SISTEr (Albo 2007): PVS vs Burch, effectiveness (no SUI, no need for retreatment, negative stress test was 66% vs 49%, retreatment rates was 4% vs 13%

Sources