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Overview of Stress Urinary Incontinence & Minimally Invasive Slings

Overview of Stress 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

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Overview of Stress Urinary Incontinence & Minimally Invasive Slings

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  1. 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

  2. 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

  3. 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

  4. SUI: Mechanism

  5. 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 SUI Treatment

  6. 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

  7. Vaginal Pessaries

  8. 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

  9. Burch Procedure

  10. Midurethral Slings

  11. Suprapubic Approach

  12. Obturator Approach Transobturator tape (TOT)

  13. 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)

  14. “Mini – Sling” TVT SECUR System

  15. 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 St. Boniface ACF Ph: 237-2713 Fax: 237-2284 Ken Maslow Urogynecology & Reconstructive Pelvic Surgery

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