AUA SUI guideline: Counsel patients, set expectations prior to treatment

A complete evaluation, including an assessment of post-void residual volume, is key when evaluating a female patient for surgery to treat stress urinary incontinence (SUI), according to a new clinical practice guideline released by AUA.

The AUA guideline panel continues to recommend a focused history, physical examination, and demonstration of leakage with increasing abdominal pressure, along with urinalysis, cultures, and other diagnostic measures if needed. In addition, patients should be counseled about the benefits and risks of both surgical and nonsurgical options for SUI, including retropubic suspensions, injectable agents, artificial urinary sphincters, and slings.

The panel analyzed four categories of treatment options-retropubic suspensions, slings, injectable agents, and artificial urinary sphincters-and provides recommendations on each. Regarding sling surgery, the panel offers the following recommendations:

Patients should be made aware of the benefits and risks of both biological and synthetic sling materials (including surgical mesh, for which the FDA recently issued an alert).

• In all patients undergoing sling surgery, the bladder and urethra must be inspected either with a rigid or flexible cystoscope prior to the conclusion of the procedure, in order to detect potential intraoperative complications.
• When concomitantly performing prolapse repair and SUI surgery, prolapse surgery should be fully completed before the sling is tensioned.

"This guideline advises physicians to counsel their patients and set expectations prior to undergoing treatment," said AUA Guideline Panel Chair Roger Dmochowski, MD, of Vanderbilt University, Nashville, TN. "This is very important because often the patient thinks that surgery will completely cure their incontinence, when in reality, it may only make modest improvements."

The new guideline, which can be viewed in its entirety online at www.AUAnet.org, replaces one issued by AUA in 1997.