New Canadian and BC Guidelines
Consider the index patient in your clinic:
A healthy 54-year-old female with bothersome stress urinary incontinence (SUI) while attempting to exercise, in which she requires the use of incontinence pads. No prior SUI surgery, BMI <40, no pelvic floor radiation, no pelvic organ prolapse, not frail.
Recommended for the Index Patient:
Cystoscopy if there are other findings (other symptoms i.e. other Lower Urinary Tract Symptoms [LUTS], previous pelvic radiation or procedure history, suspected structural causes, recurrent UTI)
Urodynamic studies (UDS) if there are other findings (history of pelvic surgery/radiation, elevated PVR, suspected voiding dysfunction, neurologic conditions of the Lower Urinary Tract [LUT], mixed incontinence, or discrepancy of history and physical)
Weight loss
Delay surgery if she is considering bariatric surgery
Smoking cessation
BOTH Self-directed pelvic floor muscle therapy (PFMT) and group-based supervised and intensive PFMT
Pessaries and other vaginal devices for candidates
May offer periurethral bulking agents as a less-invasive option to surgery
Mid-urethral sling (vaginal or obturator) unless urethral integrity is impaired
Shared decision making to offer appropriate conservative and surgical options to patients who are not done their childbearing
Discuss that sexual function may be affected after SUI surgery
Counseling that retention/worsening voiding dysfunction is a possible outcome of SUI surgery
NOT Recommended for the Index Patient
Routine cystoscopy
Routine urodynamic studies (UDS)
Topical Vaginal estrogen if stress urinary incontinence is the only symptom
Vaginal Laser therapy
Reliance on preoperative urodynamic parameters to predict postoperative voiding dysfunction
References
CUAJ April 2024 Volume 18, Issue 4, 2024 Canadian Urological Association
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