In this interview, Gopal H. Badlani, MD, discusses the shift to mid-urethral sling placement, the growth of synthetic graft materials, and the reasons for these changes in the management of female stress urinary incontinence.
Q How has the traditional approach to the surgical correction of genuine stress urinary incontinence in women changed in the last decade?
A The biggest change has been twofold. One is that the placement of the sling has moved from the bladder neck to the mid-urethra. This is a profound change in our thinking of how to treat stress incontinence. Second is the use of biomaterials, mainly synthetic materials.
Q Is there any advantage to doing the old-fashioned retropubic procedures robotically or laparoscopically?
A At present, data do not exist to show that retropubic procedures performed robotically or laparoscopically offer long-term success. Robotics has made the procedures easier to perform, but robot-assisted laparoscopy does not address all the pelvic floor defects. It may only be viable for a vault suspension, for example. It does make sense, if you're doing an abdominal approach to a vaginal vault suspension, to do a retropubic suspension at the same time, which is supported by results from a randomized trial.
Q What do you consider to be the current gold standard for the treatment of genuine stress incontinence in women?
Q Are we getting any better at evaluating the results of urinary incontinence procedures?
A I think we have better tools for measuring outcomes-both standardized questionnaires and evaluation methods. We're getting closer to defining what's successful and what's not in terms of outcomes. Unfortunately, not everybody is using standardized outcome measures, and there are no guidelines to say which outcome measures should be used. We are waiting for the new stress incontinence/pelvic organ prolapse guidelines from the AUA to be released in the very near future.