Title : Whats the best non mesh continence surgery for my patients
Abstract:
Urinary incontinence (UI) is a common and debilitating condition among women (1). In 2000, the MRC Incontinence Study showed that 34% of women (~6million) in the UK over 40 years of age have clinically significant UI with 2.7% (~0.33 million) reporting UI as socially disabling (2). This prevalence is set to increase knowing the ageing population in the western world. SUI is the most common type of UI accounting for almost 50% of cases. (3) It is defined as involuntary leakage of urine on effort, sneezing or coughing. Mixed UI (MUI) is the second most common type and is often SUI predominant (i.e. women also describe concomitant urgency and/or urgency incontinence but SUI are their predominant bothersome symptoms) (3). Initial management includes conservative therapy such as specialist physiotherapy for pelvic floor muscle training. When conservative therapy fails, in about one-third of cases, surgery is the next option (3). Current data suggests the lifetime risk for women in the UK to undergo surgery for SUI is 10% (4). Since 2014, surgical practice in the UK has significantly changed and synthetic mid-ureteral slings (mesh) have been largely replaced with other surgical procedures. The recent NICE guideline (NG123) recommends the following surgical options: Autologous fascial sling, Burch colposuspension, mid-urethral sling (mesh) and urethral bulking. In this talk we will discuss the operative steps and evidence behind non mesh surgical options. Audience Take Away: • The audience will watch short videos for the operative steps and evidence behind non mesh surgical options • The audience will be able to reflect on their own surgical practice and use this talk as a first step in ensuring they are providing their patents with appropriate surgical options
