Surgery for urinary incontinence in women 65 years and older: a systematic review

Franzén, Karin; Andersson, Gunnel; Odeberg, Jenny; Midlöv, Patrik; Samuelsson, Eva; Stenzelius, Karin; Hammarström, Margareta

doi:10.1007/s00192-014-2573-9

Cited by 17 publications

(8 citation statements)

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“…GPs in this study were also not inclined to refer older women with co-morbidity to a specialist because of perceived risks of complications after surgery. However, evidence is inconclusive about differences in complication rates between older and younger women who underwent surgery for their incontinence [38]. These discrepancies between practice and evidence correspond with the findings from literature of well-known facts that women with urinary incontinence receive suboptimal treatment [10, 14].…”

Section: Discussionmentioning

confidence: 60%

Mixed feelings: general practitioners’ attitudes towards eHealth for stress urinary incontinence - a qualitative study

et al. 2019

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BackgroundStress urinary incontinence (SUI) is the most prevalent subtype of urinary incontinence and is a bothering condition in women. Only a minority of those with SUI consult a general practitioner (GP). EHealth with pelvic floor muscle training (PFMT) is effective in reducing incontinence symptoms and might increase access to care. The role of the GP regarding such an eHealth intervention is unknown. The aim of the study is to gain insight into the attitudes towards a PFMT internet-based, eHealth, intervention for SUI.MethodsA qualitative study was conducted. Data were collected through semi-structured interviews among purposively sampled GPs. Audio records were fully transcribed, and analysed thematically.ResultsThirteen GPs were interviewed, nine females and four males. Three themes emerged: appraisal of eHealth as a welcome new tool, mixed feelings about a supportive role, and eHealth is no cure-all. GPs welcomed eHealth for SUI as matching their preferences for PFMT and having advantages for patients. With eHealth as stand-alone therapy GPs were concerned about the lack of feedback, and the loss of motivation to adhere to the intervention. Therefore, GPs considered personal support important. The GP’s decision to recommend eHealth was strongly influenced by a woman’s motivation and her age. GPs’ treatment preferences for elderly are different from those for young women with SUI; both PFMT and eHealth are perceived less suitable for older women.ConclusionEHealth with PFMT fits into the GPs’ routine practice of SUI and adds value to it. Although there is evidence that eHealth as a stand-alone intervention is effective, GPs consider personal support important to supplement the perceived shortcomings. Probably GPs are not aware of, or convinced of the existing evidence. Training should address this issue and should also focus on common misunderstandings about regular care for women with SUI, such as the idea that PFMT is not suitable for the elderly. Improving GPs’ knowledge that eHealth can be a stand-alone therapy for SUI facilitates the implementation in daily care.Electronic supplementary materialThe online version of this article (10.1186/s12875-019-0907-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 60%

Mixed feelings: general practitioners’ attitudes towards eHealth for stress urinary incontinence - a qualitative study

et al. 2019

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“…The published information on SUI surgery in older women (≥65 years of age) is sparse. A 2015 systematic review evaluated RCTs and prospective non‐randomized trials published from 1966 to October 2013 . Only five studies fulfilled the inclusion criteria and all were about suburethral slings.…”

Section: Variables Confounding Outcomes Of Surgery For Uimentioning

confidence: 99%

“…A 2015 systematic review evaluated RCTs and prospective non-randomized trials published from 1966 to October 2013. 80 Only five studies fulfilled the inclusion criteria and all were about suburethral slings. Persistent SUI after surgery varied between 5.2% and 17.6%, and one study evaluating QoL showed significant improvement after surgery.…”

Section: Outcomes Of Surgery For Uimentioning

confidence: 99%

Surgery for urinary incontinence in women: Report from the 6th international consultation on incontinence

Gomelsky

Athanasiou

Choo

et al. 2018

Neurourology and Urodynamics

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Urinary incontinence is a prevalent condition worldwide and causes a tremendous impact on a woman's quality of life. While conservative and non‐surgical therapies are options for treatment, surgery for stress urinary incontinence (SUI) is common. Options include colposuspension, slings (pubovaginal and midurethral), and periurethral bulking. While evidence supports each of these options in the treatment of SUI, each is associated with various rates of success and unique adverse event profiles. Urgency urinary incontinence (UUI) is initially treated with behavioral modification and pharmacologic means, with surgery reserved for those with refractory symptoms or significant complications from medication use. At present, intravesical onabotulinumtoxinA injections, percutaneous tibial nerve stimulation, and sacral neurostimulation are all viable options for refractory UUI/overactive bladder. As with surgical interventions for SUI, each of these is, likewise, associated with unique outcomes and adverse event profiles. Herein, we summarize the findings and conclusions from the 6th International Consultation on Incontinence (ICI) regarding surgical treatment of urinary incontinence in women.

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“…We observed that a woman's age and BMI had relatively little impact on the gynaecologists' recommendations for surgical treatment. This corresponds to an increasing body of evidence indicating that surgical treatments are effective in obese and in elderly patients [18][19][20][21][22]. On the other hand, it is also generally accepted that clinical decision-making is more complex given that overall health and functional status is poorer in these patient groups [21].…”

Section: Characteristics Levelsmentioning

confidence: 98%

Variation in surgical treatment advice for women with stress urinary incontinence: a study using clinical case vignettes

et al. 2020

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Introduction The aim of this study was to determine how recommendations of gynaecologists on surgical treatment for stress urinary incontinence (SUI) were influenced by patient characteristics. Methods Two hundred forty-five gynaecologists in the UK fully responded to an online questionnaire including 18 vignettes describing 7 clinical characteristics of women with SUI (age, body mass index, SUI type, previous SUI surgery, frequency of leakage, bother, physical status). The gynaecologists scored recommendations for surgery ranging from 1 'certainly not' to 5 'certainly yes'. Mean scores were used to calculate the relative impact ('weight') of each clinical characteristic. Latent class analysis was used to distinguish groups of gynaecologists with a particular practice style because they responded to the patient characteristics captured in the case vignettes in a similar way. Results The gynaecologists' overall average recommendation score was 2.9 (interquartile range 2 to 4). All patient characteristics significantly influenced the recommendation scores (p always < 0.001) but their impact was relatively small. SUI type was most important (weight 23%), followed by previous SUI surgery (weight 21%). Latent class analysis identified five groups of gynaecologists with practice styles that differed mainly with respect to their mean recommendation score, ranging from 1.3 to 4.0. Conclusions Surgical treatment advice in response to case vignettes was only minimally influenced by patient characteristics. There were five groups of gynaecologists whose inclination to recommend surgical treatment varied. This suggests that there is lack of consensus on the role of surgery as a treatment for SUI. A considerable number of gynaecologists were reluctant to recommend surgery.

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Surgery for urinary incontinence in women 65 years and older: a systematic review

Abstract: The suburethral sling procedure improves continence as well as QoL among elderly women with SUI; however, evidence is limited.

Cited by 17 publications

References 17 publications

Mixed feelings: general practitioners’ attitudes towards eHealth for stress urinary incontinence - a qualitative study

Mixed feelings: general practitioners’ attitudes towards eHealth for stress urinary incontinence - a qualitative study

Surgery for urinary incontinence in women: Report from the 6th international consultation on incontinence

Variation in surgical treatment advice for women with stress urinary incontinence: a study using clinical case vignettes

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