AUA releases treatment guidelines for female stress urinary incontinence - American Urological Association

The American Urological Association (AUA) conven the Female Stres Urinary Incontinence Clinical Guidelines Panel to evaluate the literature regarding surgical managements for the treatment of female stres urinary incontinence in the otherwise healthy female and to make practice recommendations based in succession the treatment outcomes data. About 280 scientific papers published since 1950 were reviewed to determine the complications and issues associated with surgical procedures for female stres urinary incontinence. A summary report of the guidelines appears in the September 1997 issue of the Journal of Urology

According to the AUA president Roy J Correa, Jr MD "(incontinence) is a widespread question that affects an estimated 13 million adults in the United States. Approximately 85 percent of those individuals are women" The panel identified the protoplast of patient to whom the recommendations apply as an otherwise healthy woman with stres urinary incontinence, either previously untreated or treated (surgically or nonsurgically), without pelvic organ prolapse, who has decided to look after surgical treatment.

Summary of Guidelines

The panel set up evidence to support surgery as an initial therapy and as a secondary form of therapy after failure of other treatments, offering a long-term corrective in a significant percentage of women Four adumbrations of surgical procedures were reviewed: retropubic suspensions; transvaginal suspensions; anterior repairs and sling manner of proceedings The AUA believes that these four marks of surgery have important differences.

According to the AUA, retropubic suspensions are performed between the walls of an incision in the lower abdomen. In this operation sutures are placed near the bladder neck and urethra, and secur to a pelvic bone or to surrounding supporting constitutions Transvaginal suspensions are described from the AUA as being performed [i]or[/i] part of to the other the vagina and through a small incision in the lower abdomen. line of junctions are placed in the tissue near the bladder neck and urethra from the vaginal side, then the line of junctions are transferred to the abdominal incision.

Anterior repairs address vaginal support of the bladder base by the agency of using the pubocervical fascia. Sling proceedings are performed partly through the vagina and partly by the agency of a small incision similar to the incision for a transvaginal suspension. This practice creates a hammock-like bolstering of the urethra. A supporting strip of material is placed in subordination to the urethra and bladder neck and secur with permanent line of junction to the abdominal wall or a pelvic bone

The data indicate that after 48 month retropubic suspensions and slings appear to be more effective than transvaginal suspensions and anterior repairs. The help rate for each of these couple procedures is about 85 percent compared with healing rates of 67 percent in transvaginal suspensions and 61 percent in anterior repairs.

However, the panel also set that retropubic suspensions and slings are associated with slightly higher complication rates when compared with the other couple cited surgical procedures. Complications include postoperative voiding dysfunction and a longer convalescence period. The literature moveed higher complication rates when synthetic materials are used for slings.

Patient Evaluation

The AUA panel powerfully recommends that a physician's evaluation of a woman who quick in emergenciess with symptoms of stress urinary incontinence should include a thorough history, including the impact of symptoms upon lifestyle; a physical examination with an objective demonstration of stres incontinence; a urinalysis, and other appropriate diagnostic studies to assess symptom causes, oftenness and severity of incontinent episodes, and patient expectations from treatment. According to the AUA, the history should include the patient's age, previous operations, neurologic conditions known to affect micturition, menstrual and obstetric history, and attendant medications. Physicians should advise their patients to withhold a micturition diary. It should include time of micturition, impressed sign of incontinence and the voided dimensions The AUA believes that it is necessary to educate patients about all four surgical options, including the risks and benefits. The patient selection should always be considered as well as the experience and decision of the surgeon.

Physicians can order the AUA's perfect report, "Management of Female Stres Urinary Incontinence Guidelines," at contacting the AUA Health Policy Department at 410-223-4367 A physician guide is also available to assist in explaining the disease and its praiseed treatments to patients. Patients can achieve information and advice regarding incontinence from contacting the American Foundation for Urologic Disease at 800242-2383

COPYRIGHT 1997 American Academy of Family Physicians

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