Overview of Stress Urinary Incontinence

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Overview ofStress Urinary Incontinence
Minimally Invasive Slings

• Ken Maslow, M.D.
• Urogynecology and Reconstructive Pelvic Surgery
• Assistant Professor Department of Obstetrics
  Gynecology
• University of Manitoba

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Etiologies of UI

• SUI Stress UI
• UUI Urge UI (OAB)
• Mixed UI
• Functional UI (DIAPPERS)
• Overflow UI
• Other
• Fistula, ectopic ureter, urethral diverticula
• Uncategorised Incontinence

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ICS SUI Definitions

• Symptom
• Complaint of involuntary leakage on effort or
  exertion, or on sneezing or coughing
• Sign
• Observation of involuntary leakage from the
  urethra, synchronous with exertion/effort, or
  sneezing or coughing
• Diagnosis
• Urodynamic SUI involuntary leakage of urine
  during CMG with increased abdominal pressure, in
  the absence of a detrusor contraction

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SUI Mechanism
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SUI Treatment

• Non surgical
• Pessary
• (Level II-III)
• Meds
• Imipramine
• Not very effective
• Duloxetine
• Not available
• Surgical

• Behavorial
• Lose weight (Level 1)
• Timed toileting/? intake (1a)
• Treat constipation
• Stop smoking (cough)
• Avoiding high impact activities/heavy lifting
• Kegels (Level 1)
• biofeedback

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Kegels / PFMT

• Level 1 evidence effective for SUI Tx
• Ensure Pt contracting correct muscles
• No one program recommended
• 3-5 sec squeeze, 10-20 cont/3-5 x per day
• Addition of biofeedback, vag cones, or electrical
  stimulation no benefit
• However in Pt who do not isolate correct muscles,
  may be benefit of biofeedback devices
• Pelvic floor physiotherapist

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Vaginal Pessaries
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Surgical Tx SUI

• Anterior colporraphy
• Kelly plication suture
• Needle suspension procedures
• Stamey, Raz, Pereyra, Gittes
• Retropubic urethropexy
• Burch, MMK
• Suburethral Sling procedures
• Traditional Slings, Minimally invasive
  midurethral slings
• Periurethral bulking procedures
• Artificial Sphincter

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Burch Procedure
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Midurethral Slings
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Suprapubic Approach
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Obturator Approach
Transobturator tape (TOT)
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(No Transcript)
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Midurethral Sling

• Day surgery
• 10-20 minute procedure
• IV Sedation local freezing
• Requires 1-2 weeks off work
• Complications Rare
• Bleeding, infection, voiding dysfunction, mesh
  erosion, de novo/worsening UUI
• TVT bladder/bowel/lg vessel injury
• TOT vaginal perforation, leg/groin pain
• Efficacy
• 90 cure at one year
• Comparable to Burch at 2 yrs F/U (RCT Ward 2004)

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Mini Sling TVT SECUR System
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Summary

• SUI is a common problem in women
• Conservative Tx
• Kegels, weight reduction, pessary, (meds)
• Surgical Tx
• Minimally invasive mid urethral slings
• Day surgery
• Quick recovery
• Little risk
• Good outcome

St. Boniface ACF Ph 237-2713 Fax [phone]
Ken Maslow Urogynecology Reconstructive Pelvic
Surgery