Guideline-Based Strategies in the Surgical Treatment of Female Urinary Incontinence: The New Gold Standard is Almost the Same as the Old One

Viereck, Volker; Bader, W.; Lobodasch, Kurt; Pauli, F; Bentler, R.; Kölbl, H.

doi:10.1055/s-0042-107079

Cited by 14 publications

(6 citation statements)

References 12 publications

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“…The surgical gold standard of SUI is represented by MUS (LOE 3, grade 1C). 39,40 MUS has a high efficacy in subjective and objective cure rates among patients with SUI, especially retropubic and transobturator MUS (LOE 1, grade 1A). 41,42 The effectiveness and safety of MUS has been reported in systemic reviews, with a follow-up time of up to 12 months (LOE 1, grade 1A).…”

Section: Mus Type Selection: Retropubic Mus Transobturator Mus and Sismentioning

confidence: 99%

FIGO recommendations: Use of midurethral slings for the treatment of stress urinary incontinence

Lau

Davila

Chen

et al. 2023

Intl J Gynecology & Obste

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Background: Stress urinary incontinence (SUI) is a global problem. It can significantly adversely impact a woman's quality of life. The use of synthetic mesh in vaginal surgery is controversial, especially when used for pelvic organ prolapse surgery. Although negative effects have been reported, the synthetic mesh midurethral sling (MUS) is considered to be safe and effective in the surgical treatment of SUI.Objectives: To provide evidence-based data and recommendations for the obstetrician/gynecologist who treats women with SUI and performs or plans to perform MUS procedures. Methods: Academic searches of MEDLINE, the Cochrane Library, Embase, and Google Scholar articles published between 1987 and March 2020 were performed by a subgroup of the Urogynecology and Pelvic Floor Committee, International Federation of Gynecology and Obstetrics (FIGO).Selection Criteria: The obtained scientific data were associated with a level of evidence according to the Oxford University Centre for Evidence-Based Medicine and GRADE Working Group system. In the absence of concrete scientific evidence, the recommendations were made via professional consensus. Results:The FIGO Urogynecology and Pelvic Floor Committee reviewed the literature and prepared this evidence-based recommendations document for the use of MUS for women with SUI.Conclusions: Despite the extensive literature, there is a lack of consensus in the optimal surgical treatment of SUI. These recommendations provide a direction for surgeons to make appropriate decisions regarding management of SUI. The MUS is considered safe and effective in the treatment of SUI, based on many high-quality scientific publications and professional society recommendations. Comprehensive long-term data and systemic reviews are still needed, and these data will become increasingly important as women live longer. These recommendations will be continuously updated through future literature reviews.

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Section: Mus Type Selection: Retropubic Mus Transobturator Mus and Sismentioning

confidence: 99%

FIGO recommendations: Use of midurethral slings for the treatment of stress urinary incontinence

Lau

Davila

Chen

et al. 2023

Intl J Gynecology & Obste

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“…Eine genaue präoperative Abklärung mit zuverlässigem Ausschluss einer neurogenen Ursache ist deshalb beim Diabetiker obligat. Alle offen operativen Verfahren und vor allem die Implantation von Sphinkterprothesen sind bei Diabetikern mit einer deutlich erhöhten Rate von intra-und/oder postoperativen Wundinfektionen verbunden, die eine Entfernung des Implantats notwendig machen [10].…”

Section: Operationen Bei Harninkontinenzunclassified

Urologische Eingriffe bei Diabetes

Tschada¹,

Tschada²

2017

Diabetes aktuell

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Die Inzidenz operationspflichtiger urologischer Erkrankungen ist bei Diabetikern erh?ht. So sind 80?% der Patienten, die im Erwachsenenalter eine Zirkumzision ben?tigen, Diabetiker. Nierentumore, gutartige Prostatavergr??erungen und Blasentumore bei M?nnern treten in Gegenwart eines Diabetes h?ufiger auf. Nur das Prostatakarzinom ist bei M?nnern mit Typ-2-Diabetes signifikant seltener anzutreffen. Die Operation eines Diabetikers ist Teamwork, die es gut zu organisieren gilt. Sofern es f?r das pr?-, intra- und postoperative Management Leitlinien gibt, sollten diese beachtet werden: So sollten alle Antidiabetika 12 Stunden vor einem Eingriff abgesetzt werden. Metformin wird bis 48 Stunden nach der Operation pausiert. Bei der Operation von Diabetikern sollte man minimalinvasiven und/oder endoskopischen Operationstechniken, soweit verf?gbar, den Vorzug geben. Beim Blasentumor ist auch beim Diabetiker die transurethrale Tumorresektion der erste Schritt. Auch gro?e operative Eingriffe wie die radikale Zystektomie und eine Darmersatzblase sind bei Diabetikern m?glich, aber mit einer h?heren postoperativen Komplikationsrate verbunden. Ob der ?da-Vinci?-Roboter hier wie bei der radikalen Prostatektomie eine Verbesserung f?r Diabetiker bedeutet, l?sst sich gegenw?rtig noch nicht absch?tzen. Die Greenlight-Laser-Ablation der Prostata ist allerdings wegen der oft langen postoperativen Rekonvaleszenz f?r Diabetiker weniger geeignet. Eine gute Alternative bei Diabetes mellitus ist die neue, bipolare Prostataresektionstechnik ohne die Gefahr einer Einschwemmung.

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“…The reason for stress incontinence is the inability of the closure system to withstand the sudden increase of the bladder pressure. Urethral or pelvic floor muscles that react too weakly or too slowly, a weak connective tissue and thin mucous membranes caused by postmenopausal estrogen deficiency, or the relaxation of urethral ligaments, can lead to urethral closure insufficiency [ 3 ]. Depending on the severity, urine may be lost in drops, splashes, or in a stream.…”

Section: Introductionmentioning

confidence: 99%

Current Treatment of Stress Urinary Incontinence by Bulking Agents and Laser Therapy—An Update

Sikora,

Gamper,

Zivanovic

et al. 2024

JCM

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Stress urinary incontinence (SUI) affects around 20% of women. In addition to the established suburethral sling insertion, two less invasive approaches are of interest today: urethral bulking agents and vaginal laser therapy. This review discusses articles through December 2023 identified by a PubMed literature search using the keywords “incontinence” and “bulking” or “laser”. Although the two approaches are less effective than sling insertions, there are specific conditions in which one or the other technique is more advantageous. Injecting bulking agents into the urethra only takes some minutes and works without general anesthesia. The method is particularly suited for elderly, frail, or obese patients with multiple comorbidities, but is also applicable for all patients and in combination with other therapies. Generally, the safety profile is good but differs between bulking materials. Two laser types—the Erbium:YAG laser with SMOOTH-mode and the fractional ablative CO2 laser—deliver heat into the tissue to induce tissue tightening and regeneration. Intravaginal laser therapy improves mild to moderate SUI, while studies describe how intraurethral laser therapy is also beneficial for severe SUI. Young women between childbirths, as well as postmenopausal women, may benefit from laser therapy. The method is safe, can be performed on an outpatient basis, and does not require any artificial material.

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Guideline-Based Strategies in the Surgical Treatment of Female Urinary Incontinence: The New Gold Standard is Almost the Same as the Old One

Cited by 14 publications

References 12 publications

FIGO recommendations: Use of midurethral slings for the treatment of stress urinary incontinence

FIGO recommendations: Use of midurethral slings for the treatment of stress urinary incontinence

Urologische Eingriffe bei Diabetes

Current Treatment of Stress Urinary Incontinence by Bulking Agents and Laser Therapy—An Update

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