1052
VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
prolapse may be the most appropriate surgical option; 4) any restriction of mesh slings for the treatment of stress incontinence is clearly not supported by any professional organization or the FDA; 5) any restriction of mesh placed abdominally for the treatment of prolapse is clearly not supported by any professional organization or the FDA; and 6) instead of a ban on mesh, the implementation of credentialing guidelines is recommended so that mesh procedures are performed by only qualified surgeons. The “mesh-mess” for repair of pelvic organ prolapse awaits further clarification. Alan J. Wein, MD, PhD (hon)
Re: Open Retropubic Colposuspension for Urinary Incontinence in Women M. C. Lapitan and J. D. Cody Division of Urology, Philippine General Hospital, Manila, Philippines Cochrane Database Syst Rev 2012; 6: CD002912.
Abstract available at http://jurology.com/
Re: Surgical Management of Female SUI: Is There a Gold Standard? A. Cox, S. Herschorn and L. Lee Division of Urology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Nat Rev Urol 2013; 10: 78e89.
Abstract available at http://jurology.com/ Editorial Comment: The Cochrane Review may represent the last formal large scale review done for open retropubic colposuspension, the previous gold standard for stress urinary incontinence correction. The review included 53 trials involving 5,244 women. Overall cure rates were 69% to 88%. Evidence from 20 trials in comparison with suburethral slings (either transvaginal or transobturator) found no significant differences in incontinence rates for any period assessed. The summary statement is that within the first year of treatment the overall continence rate is 85% to 90%, and after 5 years approximately 70% of patients can expect to be dry. The article by Cox et al represents an excellent short review of all procedures for stress incontinence in the woman and categorizes open retropubic colposuspension as a procedure that might be considered for women undergoing a concomitant open abdominal procedure. These authors describe the new gold standard as the mid urethral synthetic sling, inserted either retropubically/transvaginally or via a transobturator approach. Pubovaginal slings are categorized as effective and especially useful in those who have failed other procedures, who have had urethral mesh complications or who require a concomitant urethral reconstructive procedure (eg for urethral fistula, urethral diverticulum or destroyed urethra). The retropubic approach for mid urethral sling placement is categorized as offering a slight advantage over the transobturator approach in terms of successful outcomes but with a somewhat higher rate of perioperative complications. Regarding single incision slings, the authors cite a meta-analysis from 2011 concluding that although these procedures are safe and associated with little morbidity, they were found to be inferior to standard mid urethral synthetic slings for the treatment of stress urinary incontinence. With respect to patients with mixed urinary incontinence, the authors conclude that both retropubic and transobturator mid urethral slings are effective but the overall cure rate is lower than that for patients with pure stress urinary incontinence. The review by Cox et al includes 98 well chosen articles. At this point it would seem prudent for the American Urological Association to consider an update of the guidelines on the surgical management of female stress urinary incontinence.1 Alan J. Wein, MD, PhD (hon) 1. Dmochowski RR, Blaivas JM, Gormley EA et al: Update of AUA guideline on the surgical management of female stress urinary incontinence. J Urol 2010; 183: 1906.
VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
prolapse may be the most appropriate surgical option; 4) any restriction of mesh slings for the treatment of stress incontinence is clearly not supported by any professional organization or the FDA; 5) any restriction of mesh placed abdominally for the treatment of prolapse is clearly not supported by any professional organization or the FDA; and 6) instead of a ban on mesh, the implementation of credentialing guidelines is recommended so that mesh procedures are performed by only qualified surgeons. The “mesh-mess” for repair of pelvic organ prolapse awaits further clarification. Alan J. Wein, MD, PhD (hon)
Re: Open Retropubic Colposuspension for Urinary Incontinence in Women M. C. Lapitan and J. D. Cody Division of Urology, Philippine General Hospital, Manila, Philippines Cochrane Database Syst Rev 2012; 6: CD002912.
Abstract available at http://jurology.com/
Re: Surgical Management of Female SUI: Is There a Gold Standard? A. Cox, S. Herschorn and L. Lee Division of Urology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Nat Rev Urol 2013; 10: 78e89.
Abstract available at http://jurology.com/ Editorial Comment: The Cochrane Review may represent the last formal large scale review done for open retropubic colposuspension, the previous gold standard for stress urinary incontinence correction. The review included 53 trials involving 5,244 women. Overall cure rates were 69% to 88%. Evidence from 20 trials in comparison with suburethral slings (either transvaginal or transobturator) found no significant differences in incontinence rates for any period assessed. The summary statement is that within the first year of treatment the overall continence rate is 85% to 90%, and after 5 years approximately 70% of patients can expect to be dry. The article by Cox et al represents an excellent short review of all procedures for stress incontinence in the woman and categorizes open retropubic colposuspension as a procedure that might be considered for women undergoing a concomitant open abdominal procedure. These authors describe the new gold standard as the mid urethral synthetic sling, inserted either retropubically/transvaginally or via a transobturator approach. Pubovaginal slings are categorized as effective and especially useful in those who have failed other procedures, who have had urethral mesh complications or who require a concomitant urethral reconstructive procedure (eg for urethral fistula, urethral diverticulum or destroyed urethra). The retropubic approach for mid urethral sling placement is categorized as offering a slight advantage over the transobturator approach in terms of successful outcomes but with a somewhat higher rate of perioperative complications. Regarding single incision slings, the authors cite a meta-analysis from 2011 concluding that although these procedures are safe and associated with little morbidity, they were found to be inferior to standard mid urethral synthetic slings for the treatment of stress urinary incontinence. With respect to patients with mixed urinary incontinence, the authors conclude that both retropubic and transobturator mid urethral slings are effective but the overall cure rate is lower than that for patients with pure stress urinary incontinence. The review by Cox et al includes 98 well chosen articles. At this point it would seem prudent for the American Urological Association to consider an update of the guidelines on the surgical management of female stress urinary incontinence.1 Alan J. Wein, MD, PhD (hon) 1. Dmochowski RR, Blaivas JM, Gormley EA et al: Update of AUA guideline on the surgical management of female stress urinary incontinence. J Urol 2010; 183: 1906.
