The index patient was defined as a healthy female who is considering surgery for SUI who has had no previous SUI surgery and a low stage/grade prolapse. The non-index patient is one with high grade prolapse (stage 3 or 4), mixed UI, elevated PVR, voiding dysfunction, prior surgery for SUI, recurrent/persistent SUI, mesh complications, high BMI, neurogenic LUTD, advanced age. Initial evaluation remains history, physical and diagnostics which depends on the patients comorbidities.
The guideline does not recommend cystoscopy on the index patient and UDS may also be omitted if SUI is clearly demonstrated. UDS is recommended in the non-index patient. This guideline emphasizes patient counseling as degree of bother should be considered in the decision for therapy. Patients should be counseled on observation, pelvic floor muscle training, non-surgical options (e. g. incontinence pessary, vaginal inserts) and surgical interventions. Possible surgical complications, risks benefits and alternatives to mesh should be reviewed. Surgical options or the index patient include midurethral sling (synthetic), autologous fascia pubovaginal sling, Burch colposuspension and bulking agents. Specific cases include those patient with a fixed, immobile urethra, concomitant surgery for prolapse, avoidance of mesh in patients at risk for poor wound healing, those with neurologic decease that affects the lower urinary tract. Patient should be counseled on possible complications in the early postoperative period (e.g. dyspareunia, obstruction, persistent pain, UTIs, mesh-specific complications).
Presented by: Kathleen Kobashi, MD; Virginia Mason, Seattle, WA
Written by: Diane K. Newman, DNP, FAAN, BCB-PMD, Perelman School of Medicine, University of Pennsylvania
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA