Female Pelvic Medicine and Reconstructive Surgery challenges on behalf of the Collaborative Research in Pelvic Surgery Consortium: managing complicated cases

Brennand, Erin A.; Uğurlucan, Funda Güngör; Brown, Heidi W.; Jeffery, Stephen; Campbell, Patrick; Grimes, Cara L.; Yurteri-Kaplan, Ladin A.

doi:10.1007/s00192-020-04385-3

Cited by 4 publications

(2 citation statements)

References 27 publications

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“…No high-quality studies allow comparison of different treatments as secondary treatments, so guidance is based on the expert opinion of the panel and other authors and organizations. 132,[139][140][141][142][143][144] Salvage surgery may be associated with lower success rates, especially in those with more bothersome symptoms, and higher surgical risk CUA guideline: SUI than primary surgery. [145][146][147][148] Referral to a tertiary center should be considered on an individual basis.…”

Section: How Should Recurrent Fsui After Mus Be Investigated and Mana...mentioning

confidence: 99%

2024 Canadian Urological Association guideline: Female stress urinary incontinence

Carlson,

Andrews,

Bascom

et al. 2024

CUAJ

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prior to publication, this guideline underwent review by the cua guidelines steering committee and expert reviewers. INTRODUCTION & PURPOSEFemale stress urinary incontinence (FSUI) is a common condition that affects approximately 10-20% of the population. 1 It is associated with negative impacts on quality of life (QoL), socialization, and exercise; it has a significant financial impact, and is associated with depression and anxiety. 2 In 2012, the last Canadian Urological Association (CUA) guideline addressing adult urinary incontinence was published; it covered male and female nonneurogenic stress and urgency incontinence. 3 Given the considerable changes in the management of FSUI, and the very distinct considerations and surgical procedures for this group, an individual guideline providing a more detailed overview of this topic was requested by the CUA Guidelines Steering Committee.The specific population this guideline is intended to cover is women over 18 years of age with stress urinary incontinence. This CUA guideline is intended to be used by healthcare providers treating patients with FSUI. The guideline objective is to cover topics important to the evaluation, counselling, non-surgical and surgical treatment of FSUI, and the management of complications of FSUI surgery.Given the significant variation in patients with FSUI, in some sections we focus on the evaluation and management of the "index patient" (similar to other guidelines). 4,5 Other sections are dedicated to specific nonindex patients with FSUI. We recognize that guidelines cannot address the management of all FSUI scenarios. METHODOLOGYWe decided to use a question-and-answer format to provide brief, accessible, and practical answers to common questions addressing the evaluation and management of FSUI. The guideline panel was created to provide representation from a mix of community and academic urologists and allied health professionals from across Canada, in keeping with the CUA guideline rules. Disagreements during the guideline process were resolved by consensus-building. Conflicts of interests for the authors are included at the end of the guideline. The views or interests of the CUA did not influence the final set of recommendations.The guideline panel was led by Dr. Kevin Carlson and Dr. Blayne Welk. The group first met virtually in December 2021. Objectives to guide the development of this document were agreed upon: 1) to be comprehensive without replicating existing evidence reviews; 2) to provide evidence-based and expert-based opinions on relevant topics within FSUI; and 3) to address the unique needs of Canadian urologists where appropriate.All guideline members were asked to submit relevant topics that could be addressed in a questionand-answer format, and the final list of questions was agreed upon by the panel. Further feedback was received from CUA members at the 2022 CUA annual meeting. Individual sections were assigned to members, with another panel member acting as primary reviewer. Members reviewed publications relevant to ...

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Section: How Should Recurrent Fsui After Mus Be Investigated and Mana...mentioning

confidence: 99%

2024 Canadian Urological Association guideline: Female stress urinary incontinence

Carlson,

Andrews,

Bascom

et al. 2024

CUAJ

View full text Add to dashboard Cite

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“…Severe cases are recommended for surgical intervention to provide support to the pelvic floor using mid-urethral slings with synthetic sub-urethral tape or mesh ( Oliphant et al, 2009 ; Dwyer and Karmakar, 2019 ), which remains the most common surgical procedure for patients with SUI with success rate of 72–77% at 24 months ( Imamura et al, 2019 ). Unfortunately, 12% of those implanted with SUI slings suffer from at least one serious adverse event such as pain, mesh exposure, dyspareunia, voiding dysfunction, urge incontinence, vaginal wall erosion, or recurrent urinary tract infections ( Gomes et al, 2017 ; Gurol-Urganci et al, 2018 ; FDA, 2019 ; Keslar et al, 2020 ), and approximately 4% of patients have to adjust or remove the implant 60 months after initial surgery ( Clancy et al, 2019 ; Brennand et al, 2020 ). Understanding the anatomy and physiology of individual components will pave the way for the development of personalized diagnosis and more effective treatment options in pelvic floor disorders.…”

Section: Introductionmentioning

confidence: 99%

Secondary urethral sphincter function of the rabbit pelvic and perineal muscles

Hernández-Reynoso

Rahman²,

Hedden³

et al. 2023

Front. Neurosci.

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Perineal and pelvic floor muscles play an important role in continence by providing mechanical support to pelvic organs. It is also known that the pubococcygeus muscle (PcM) contracts in the storage phase and is inactive during voiding, while the bulbospongiosus muscle (BsM) is active during the voiding phase. Recent evidence suggested an additional role of these muscles in supporting urethral closure in rabbits. However, the individual role of perineal and pelvic muscles as urethral sphincters is not well-defined. Here we evaluated the individual, sequential and synergistic roles of the PcM and BsM in assisting urethral closure and defined the optimal electrical stimulation parameters that can effectively contract these muscles and increase the urethral pressure (Pura) in young nulliparous animals (n = 11). Unilateral stimulation of either the BsM or PcM at 40 Hz induced modest increases in average Pura (0.23 ± 0.10 and 0.07 ± 0.04 mmHg, respectively). Investigation on the changes in Pura evoked by stimulation frequencies between 5 and 60 Hz show that sequential contralateral PcM-BsM activation at 40 Hz induced a 2-fold average Pura increase (0.23 ± 0.07 mmHg) compared to that evoked by PcM stimulation. Simultaneous activation of PcM and BsM at 40 Hz also showed an increased average Pura (0.26 ± 0.04 mmHg), with a 2-fold increase in average Pura observed during the unilateral sequential PcM-BsM stimulation at 40 Hz (0.69 ± 0.2 mmHg). Finally, stimulation at 40 Hz of the bulbospongiosus nerve (BsN) induced an approximate 4-fold increase in average Pura (0.87 ± 0.44 mmHg; p < 0.04) compared to that elicited by BsM stimulation, confirming that direct nerve stimulation is more effective. Together, this study shows that in the female rabbit, both perineal and pelvic muscles support of the urethral function during continence, and that unilateral stimulation of the BsN at 40–60 Hz is sufficient to achieve maximal secondary sphincter activity. The results also support the potential clinical value of neuromodulation of pelvic and perineal nerves as bioelectronic therapy for stress urinary incontinence.

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