The evidence basis for therapy selection in women who have failed primary stress urinary incontinence (SUI) surgery is limited. The ICI-RS group discussed the available data at its meeting in June 2023, particularly the anatomical characteristics as assessed using magnetic resonance imaging (MRI) and ultrasound (US) modalities, functional characteristics associated with storage and voiding urodynamic assessment, as well as the patient characteristics that might influence outcomes. This paper summarizes the evidence base that supported these discussions and offers the basis for research proposals for future groups.
A literature search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials was performed, and the data is presented. Research questions are based on the knowledge gaps highlighted.
Possible MRI parameters that may influence outcomes were striated urethral sphincter volume, bladder and proximal urethral funneling, pubo-urethral ligament integrity, distance of the bladder neck below the pubococcygeal line, posterior urethra-vesical angle, and bladder neck to levator ani distance. US parameters included sling distance to the urethral lumen and pubis, sling position, bladder neck mobility, and lateral arm asymmetry, twisting, or curling. Urodynamic parameters included detrusor overactivity, Valsalva leak point pressure, maximum urethral closure pressure, and bladder outlet obstruction. Important patient parameters included body mass index, age, and previous interventions.
Identifying and quantifying causative factors in patients with recurrent SUI, that allow clinicians to modify subsequent treatment choices and techniques may help reduce treatment failure and complications. Formulating algorithms is the next step in optimizing patient counseling, surgical selection, and healthcare allocation.
Neurourology and urodynamics. 2023 Nov 08 [Epub ahead of print]
Jeremy Ockrim, Rohna Kearney, D Carolina Ochoa, Hashim Hashim, Gommert Van Koeveringe, Christopher Chermansky, Linda Cardozo, Alan Wein, Paul Abrams
University College London Hospital NHS Trust, University College London, London, UK., Warrell Unit, Saint Mary's Hospital, Manchester University NHS Trust, UK., Bristol Urological Institute, Bristol, UK., Maastricht university Medical Center, Maastricht, Netherlands., UPMC Magee Women's Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA., King's College Hospital, London, UK., Desai Sethi Institute of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA., Division of Developmental Biology & Medicine, School of Medical Sciences, University of Manchester, Manchester, UK.