Treatment options for patients with suboptimal response to surgery for stress urinary incontinence.
BACKGROUND
Many women with stress urinary incontinence (SUI) undergo surgery to relieve their symptoms. Currently, tension-free vaginal tape or transobturator tape sling procedures are the surgical treatments of choice. Although these procedures are often successful, a growing number of women experience suboptimal results ranging from improvement without cure to postoperative failure. Follow-up surgery often improves residual or recurrent symptoms but generally carries lower success rates and higher complication risks. Additionally, many women with suboptimal results are reluctant to undergo further surgery.


METHODS
A PubMed literature search for studies of SUI treatment options published from 1986 to 2006 was performed.


RESULTS
The literature revealed a gap in published studies addressing non-surgical options for patients with failed SUI surgeries. Studies of non-surgical treatments for SUI often exclude women who have had prior surgeries, or do not analyze this subgroup. It is, therefore, difficult to assess non-surgical treatment options for women with failed surgeries. Women whose residual or recurring SUI is attributable to intrinsic sphincter deficiency may instead elect the injection of a bulking agent. Bulking agents are associated with a low rate of complications but frequently require several injections to be successful. Women experiencing suboptimal surgical results whose SUI is attributable to hypermobility may select a new non-surgical treatment, radiofrequency collagen denaturation. This non-invasive procedure has also demonstrated a low rate of complications.


CONCLUSIONS
Considering the effect of SUI symptoms on women's quality of life, and with more women experiencing suboptimal results after surgery for SUI, it is important to assess alternatives to further surgery.
Appell
Rodney A
RA
Baylor College of Medicine, Houston, TX 77030, USA. rappell@bcm.tmc.edu
Davila
G Willy
GW
D018674:Adrenergic Antagonists / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001676:Biofeedback, Psychology; D019090:Case Management; D003094:Collagen / Q000528:radiation effects; D000068736:Duloxetine Hydrochloride; D015914:Estrogen Replacement Therapy; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007267:Injections; D010570:Pessaries; D011183:Postoperative Complications / Q000453:epidemiology; D019736:Prostheses and Implants; D011788:Quality of Life; D000078702:Radiofrequency Therapy; D012086:Reoperation / Q000523:psychology; D013876:Thiophenes / Q000627:therapeutic use; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000188:drug therapy / Q000523:psychology / Q000601:surgery / Q000628:therapy*
D018674:Adrenergic Antagonists; D000929:Antidepressive Agents, Tricyclic; D013876:Thiophenes; D003094:Collagen; D000068736:Duloxetine Hydrochloride