GYN

Surgery for Urinary Incontinence – When the Sling’s the Thing

CLINICAL ACTIONS:

Surgery may be indicated for women with stress (not urge) urinary incontinence who have failed conservative management (see ‘Related ObG Topics’ below) or who decline conservative management
Synthetic mid-urethral mesh slings are the most common primary surgical treatment for women with stress urinary incontinence (SUI) and are recognized as standard of care by the AUGS and others
Slings may be retropubic or transobturator
Subjective cure rates range from 62% to 97% and are similar for both approaches

SYNOPSIS:

Surgery for stress urinary incontinence (SUI) is generally well tolerated with excellent cure rates for either retropubic or transobturator mesh slings. Voiding dysfunction, bladder perforation, vascular and/or visceral injury as well as operative blood loss are more common with retropubic slings. Groin pain, sometimes debilitating, is more common with transobturator slings. Autologous fascial bladder slings are appropriate in women with severe SUI and a nonmobile, fixed urethra (generally secondary to scarring from previous surgery), urethral diverticula or fistula, or complications from previously placed vaginal mesh.

KEY POINTS:

Women with both pelvic organ prolapse and SUI should have concomitant surgical treatment of both
Women with pelvic organ prolapse and no SUI may develop SUI after surgical correction of prolapse, and should be evaluated preoperatively by performing a cough stress test, with the prolapse reduced
Women with pelvic organ prolapse, and without SUI who are undergoing either abdominal or vaginal prolapse repair should be counseled that postoperative SUI may occur unless an additional procedure is performed to prevent it
- The risk of adverse effects is increased with the additional procedure