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Overview of Stress Urinary Incontinence & Minimally Invasive Slings Ken Maslow, M.D. Urogynecology and Reconstructive Pelvic Surgery Assistant Professor.

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Presentation on theme: "Overview of Stress Urinary Incontinence & Minimally Invasive Slings Ken Maslow, M.D. Urogynecology and Reconstructive Pelvic Surgery Assistant Professor."— Presentation transcript:

1 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

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 SUI Treatment 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

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

14 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)

15 “Mini – Sling” TVT SECUR System

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


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