Document Detail

Guidelines for the evaluation and treatment of recurrent urinary incontinence following pelvic floor surgery.
MedLine Citation:
PMID:  21050525     Owner:  NLM     Status:  MEDLINE    
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).
Danny Lovatsis; William Easton; David Wilkie;
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Publication Detail:
Type:  Journal Article; Practice Guideline; Review    
Journal Detail:
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:
Created Date:  2010-11-05     Completed Date:  2010-12-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101126664     Medline TA:  J Obstet Gynaecol Can     Country:  Canada    
Other Details:
Languages:  eng; fre     Pagination:  893-904     Citation Subset:  IM    
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MeSH Terms
Pelvic Floor / surgery*
Postoperative Complications / diagnosis*,  therapy*
Urinary Bladder, Overactive / etiology,  therapy
Urinary Incontinence / etiology*,  therapy*
Urination Disorders / etiology,  therapy
Vaginal Fistula / etiology,  therapy
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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