Early surgery helps female stress incontinence
Panel issues new guidelines
Treating female stress urinary incontinence initially with surgery provides an effective long-term cure for most patients, according to treatment guidelines released by the American Urological Association (AUA)."These guidelines for the first time provide well-documented data regarding the effectiveness of surgery to treat this common problem," says Gary E. Leach, MD, who chaired the AUA panel of experts that developed the treatment guidelines. Leach is director of the Tower Urology Institute for Continence at the Cedars-Sinai Medical Center in Los Angeles and associate clinical professor of urology at the University of California at Los Angeles.
According to AUA President Roy J. Correa Jr., MD, a urologist at the Virginia Mason Clinic in Seattle, urinary incontinence affects an estimated 13 million adults in the United States, approximately 85% of them women.
Incontinence is recognized as a major risk factor associated with pressure ulcers, especially among the elderly. Exposure to moisture from incontinence heightens the skin’s susceptibility to breakdown by increasing the frictional coefficient, which leads to damage from rubbing and shearing. Moisture also increases the skin’s permeability to irritants and promotes microbial growth.
Incontinence is categorized into four different types: 1) stress incontinence in which leakage occurs because of physical activity; 2) urge incontinence in which leakage occurs because of a sudden strong urge to urinate; 3) mixed incontinence, which is a combination of stress and urge incontinence; and 4) overflow incontinence, in which leakage occurs as a frequent or constant dribble.
"Since female urinary stress incontinence is by far the most common of these categories, the AUA guidelines specifically address surgical treatment options for this disorder," says Correa.
A thorough review and analysis of the peer-reviewed medical literature provided strong evidence to support the use of surgery as an initial therapy, says Mayo Clinic’s Joseph Segura Jr., MD, chair of the AUA Practice Parameters, Guidelines, and Standards Committee. The data also support surgery as a secondary form of therapy after failure of other management options.
Leach explains that stress incontinence is most often caused by weakened pelvic muscles that support the bladder, bladder neck and urethra. These muscles can weaken due to pregnancy and childbirth, and prior pelvic surgery. With weakened support, the bladder neck, and urethra may shift from their normal positions, causing them to drop momentarily. The sphincter is then unable to maintain closure in the "dropped" position when there is pressure on the bladder from an activity, such as coughing.
Also cited as a standard of care by the panel is fully and clearly informing each patient of the available surgical alternatives, including estimated benefits and risk of each procedure.
A copy of the AUA’s Management of Female Stress Urinary Incontinence Guidelines can be obtained by contacting the American Urological Association Health Policy Department at (410) 223-4367.
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