Choosing the right sling for your patient

Recent data has demonstrated a one in five lifetime risk of a woman requiring stress urinary incontinence (SUI) surgery. Currently, most women opt for a synthetic midurethral sling (MUS), with over 3.6 million placed worldwide. This article attempts to identify whether a gold standard exists with regards to surgical correction of female SUI.When considering which sling type to use for which incontinent woman, the published data demonstrates excellent results for both synthetic mesh (retropubic or transobturator routes) and fascial pubovaginal slings for most patients. Intrinsic sphincter deficiency does appear to be better treated with the use of a retropubic approach, although still with less than stellar results. With little to differentiate, the treatment of most female SUI may be solely based on which sling the surgeon feels most comfortable performing. Currently, most urologists and gynecologists favour synthetic MUS over fascial slings in surgical-naïve patients; however, recent U.S Food and Drug Administration (FDA) warnings concerning the use of mesh in transvaginal surgery have patients questioning the safety of synthetic MUS for the treatment of SUI.

Urinary Incontinence Evaluation and the Utility of Pessaries in Older Women

Urinary incontinence and pelvic organ prolapse are common conditions affecting the elderly. A careful evaluation of urinary incontinence, including history and physical examination, will often determine the etiology of this condition. Vaginal pessaries are a safe and effective treatment for both urinary incontinence and pelvic organ prolapse. They should be considered a viable alternative to surgery especially in the elderly with complicated medical histories. This article reviews the etiology of urinary incontinence, offers a guide in the evaluation of the incontinent woman, and reviews the use of pessaries for the treatment of incontinence and pelvic organ prolapse.