ABSTRACT
OBJECTIVE: To provide general gynaecologists and urogynaecologists with clinical guidelines for the management of recurrent urinary incontinence after pelvic floor surgery. OPTIONS: Evaluation includes history and physical examination, multichannel urodynamics, and possibly cystourethroscopy. Management includes conservative, pharmacological, and surgical interventions. OUTCOMES: These guidelines provide a comprehensive approach to the complicated issue of recurrent incontinence that is based on the underlying pathophysiological mechanisms. EVIDENCE: Published opinions of experts, and evidence from clinical trials where available. VALUES: The quality of the evidence is rated using the criteria described by the Canadian Task Force on Preventive Health Care (Table).
Subject(s)
Postoperative Complications/diagnosis , Urinary Incontinence/diagnosis , Female , Gynecologic Surgical Procedures/adverse effects , Humans , Pelvic Floor/surgery , Postoperative Complications/etiology , Postoperative Complications/therapy , Recurrence , Urinary Incontinence/etiology , Urinary Incontinence/therapyABSTRACT
OBJECTIVE: To provide general gynaecologists and urogynaecologists with clinical guidelines for the management of recurrent urinary incontinence after pelvic floor surgery. OPTIONS: Evaluation includes history and physical examination, multichannel urodynamics, and possibly cystourethroscopy. Management includes conservative, pharmacological, and surgical interventions. OUTCOMES: These guidelines provide a comprehensive approach to the complicated issue of recurrent incontinence that is based on the underlying pathophysiological mechanisms. EVIDENCE: Published opinions of experts, and evidence from clinical trials where available. VALUES: The quality of the evidence is rated using the criteria described by the Canadian Task Force on Preventive Health Care (Table). RECOMMENDATIONS: 1. Thorough evaluation of each patient should be performed to determine the underlying etiology of recurrent urinary incontinence and to guide management. (II-3B) 2. Conservative management options should be used as the first line of therapy. (III-C) 3. Patients with a hypermobile urethra, without evidence of intrinsic sphincter deficiency, may be managed with a retropubic urethropexy (e.g., Burch procedure) or a sling procedure (e.g., mid-urethral sling, pubovaginal sling). (II-2B) 4. Patients with evidence of intrinsic sphincter deficiency may be managed with a sling procedure (e.g., mid-urethral sling, pubovaginal sling). (II-3B) 5. In cases of surgical treatment of intrinsic sphincter deficiency, retropubic tension-free vaginal tape should be considered rather than transobturator tape. (I-B) 6. Patients with significantly decreased urethral mobility may be managed with periurethral bulking injections, a retropubic sling procedure, use of an artificial sphincter, urinary diversion, or chronic catheterization. (III-C) 7. Overactive bladder should be treated using medical and/or behavioural therapy. (II-2B) 8. Urinary frequency with moderate elevation of post-void residual volume may be managed with conservative measures such as drugs to relax the urethral sphincter, timed toileting, and double voiding. Intermittent self-catheterization may also be used. (III-C) 9. Complete inability to void with or without overflow incontinence may be managed by intermittent self-catheterization or urethrolysis. (III-C) 10. Fistulae should be managed by an experienced physician. (III-C).
Subject(s)
Pelvic Floor/surgery , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Urinary Incontinence/etiology , Urinary Incontinence/therapy , Female , Humans , Recurrence , Urinary Bladder, Overactive/etiology , Urinary Bladder, Overactive/therapy , Urination Disorders/etiology , Urination Disorders/therapy , Vaginal Fistula/etiology , Vaginal Fistula/therapyABSTRACT
The symptoms of overactive bladder (OAB) -- urinary urgency, frequency, and urge incontinence -- can cause significant lifestyle limitations. Social isolation, depression, employment difficulties, and relationship stress are common findings in patients with this condition. This article focuses on women with OAB who are seen in primary care. Occasionally, OAB (or detrusor overactivity) may be the result of neurological disease, metabolic disease, or urinary tract abnormalities. Primary care practitioners can play a key role in identifying affected individuals by including a focused question in every annual patient physical assessment. Investigation and treatment can then be initiated, beginning with behavioral modification strategies (such as modifying fluid intake) and adding antimuscarinic pharmacotherapy or possibly local estrogen therapy where needed. Only patients with certain concurrent diseases or those who are refractory to conventional management will require referral to a specialist.
Subject(s)
Quality of Life , Urinary Bladder, Overactive/epidemiology , Urinary Bladder, Overactive/therapy , Urinary Incontinence, Stress/epidemiology , Urinary Incontinence, Stress/therapy , Age Distribution , Aged , Aged, 80 and over , Combined Modality Therapy , Female , Humans , Incidence , Middle Aged , Muscarinic Antagonists/adverse effects , Muscarinic Antagonists/therapeutic use , Patient Care/standards , Patient Care/trends , Prognosis , Risk Assessment , Severity of Illness Index , Suburethral Slings , Treatment Outcome , Urinary Bladder, Overactive/diagnosis , Urinary Incontinence, Stress/diagnosis , UrodynamicsABSTRACT
This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.
