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Overview of Stress Urinary Incontinence & Minimally Invasive Slings Ken Maslow, M.D. Urogynecology...
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Transcript of Overview of Stress Urinary Incontinence & Minimally Invasive Slings Ken Maslow, M.D. Urogynecology...
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
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
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
SUI: Mechanism
SUI Treatment• Behavorial
– Lose weight (Level 1)
– Timed toileting/↓ intake (1a)
– Treat constipation– Stop smoking (cough)– Avoiding high impact
activities/heavy lifting– Kegels (Level 1)
• ± biofeedback
• Non surgical– Pessary
• (Level II-III)
– Meds• Imipramine
– Not very effective
• Duloxetine– Not available
• Surgical
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
Vaginal PessariesVaginal Pessaries
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
Burch Procedure
Midurethral Slings
Suprapubic Approach
Obturator Approach
Transobturator tape (TOT)
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)
“Mini – Sling”TVT SECUR System
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
Ken MaslowUrogynecology & Reconstructive
Pelvic Surgery
St. Boniface ACFPh: 237-2713Fax: 237-2284