| Guidelines for the evaluation and treatment of recurrent urinary incontinence following pelvic floor surgery. | |
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MedLine Citation:
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PMID: 21050525 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To provide general gynaecologists and urogynaecologists with clinical guidelines for the management of recurrent urinary incontinence after pelvic floor surgery. OPTIONS: Evaluation includes history and physical examination, multichannel urodynamics, and possibly cystourethroscopy. Management includes conservative, pharmacological, and surgical interventions. OUTCOMES: These guidelines provide a comprehensive approach to the complicated issue of recurrent incontinence that is based on the underlying pathophysiological mechanisms. EVIDENCE: Published opinions of experts, and evidence from clinical trials where available. VALUES: The quality of the evidence is rated using the criteria described by the Canadian Task Force on Preventive Health Care (Table). RECOMMENDATIONS: 1. Thorough evaluation of each patient should be performed to determine the underlying etiology of recurrent urinary incontinence and to guide management. (II-3B) 2. Conservative management options should be used as the first line of therapy. (III-C) 3. Patients with a hypermobile urethra, without evidence of intrinsic sphincter deficiency, may be managed with a retropubic urethropexy (e.g., Burch procedure) or a sling procedure (e.g., mid-urethral sling, pubovaginal sling). (II-2B) 4. Patients with evidence of intrinsic sphincter deficiency may be managed with a sling procedure (e.g., mid-urethral sling, pubovaginal sling). (II-3B) 5. In cases of surgical treatment of intrinsic sphincter deficiency, retropubic tension-free vaginal tape should be considered rather than transobturator tape. (I-B) 6. Patients with significantly decreased urethral mobility may be managed with periurethral bulking injections, a retropubic sling procedure, use of an artificial sphincter, urinary diversion, or chronic catheterization. (III-C) 7. Overactive bladder should be treated using medical and/or behavioural therapy. (II-2B) 8. Urinary frequency with moderate elevation of post-void residual volume may be managed with conservative measures such as drugs to relax the urethral sphincter, timed toileting, and double voiding. Intermittent self-catheterization may also be used. (III-C) 9. Complete inability to void with or without overflow incontinence may be managed by intermittent self-catheterization or urethrolysis. (III-C) 10. Fistulae should be managed by an experienced physician. (III-C). |
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Authors:
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Danny Lovatsis; William Easton; David Wilkie; |
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Publication Detail:
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Type: Journal Article; Practice Guideline; Review |
Journal Detail:
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Title: Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC Volume: 32 ISSN: 1701-2163 ISO Abbreviation: J Obstet Gynaecol Can Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-11-05 Completed Date: 2010-12-23 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101126664 Medline TA: J Obstet Gynaecol Can Country: Canada |
Other Details:
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Languages: eng; fre Pagination: 893-904 Citation Subset: IM |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Female Humans Pelvic Floor / surgery* Postoperative Complications / diagnosis*, therapy* Recurrence Urinary Bladder, Overactive / etiology, therapy Urinary Incontinence / etiology*, therapy* Urination Disorders / etiology, therapy Vaginal Fistula / etiology, therapy |
| Investigator | |
Investigator/Affiliation:
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Jens-Erik Walter / ; Annette Epp / ; Scott Farrell / ; Lise Girouard / ; Chander Gupta / ; Marie-Andrée Harvey / ; Annick Larochelle / ; Magali Robert / ; Sue Ross / ; Joyce Schacter / ; Jane Schulz / |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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