Management of female stress urinary incontinence: A care pathway and update

Stress urinary incontinence (SUI) is a condition characterized by an involuntary loss of urine occurring as result of an increase in intra-abdominal pressure due to effort or exertion or on sneezing or coughing. Estimates of its prevalence in the female population range from 10% to 40%. A literature search of the Medline, Cochrane library, EMBASE, NLH, ClinicalTrials.gov and Google Scholar databases was done up to July 2017, restricted to English-language articles, using terms related to SUI, medical therapy, surgical therapy and treatment options. The search terms included female stress urinary incontinence, mid-urethral sling, tension-free vaginal tape (TVT) and transobturator tape (TOT, TVT-O). Original articles, reviews and meta-analyses were included. Surgical therapy should be considered only after conservative therapies (e.g. an exercise programme or topical estrogens) have failed. Synthetic mid-urethral slings are the gold standard for the surgical treatment of SUI according to the 2016 guidelines of the European Society of Urology (ESU) and the 2017 position statement of the European Urogynaecological Association (EUA). The therapeutic options are numerous but further research into new therapeutic strategies is needed to achieve a better balance between efficacy and adverse events.

Maturitas. 2017 Dec 09 [Epub]

Giampiero Capobianco, Massimo Madonia, Sonia Morelli, Francesco Dessole, Davide De Vita, Pier Luigi Cherchi, Salvatore Dessole

Gynecologic and Obstetric Clinic, Dep. of Clinical and Experimental Medicine, University of Sassari. Electronic address: ., Urologic Clinic, Dep. of Clinical and Experimental Medicine, University of Sassari., Gynecologic and Obstetric Clinic, Dep. of Clinical and Experimental Medicine, University of Sassari., Chronic Pelvic Pain Centre, Dep. of Obstetrics and Gynaecology, Ospedale S. Maria Della Speranza, Battipaglia, Italy.

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