-Definition: SUI = involuntary loss of urine on effort, physical exertion, sneezing or coughing that is bothersome to the patient and often affects quality of life.
–History & physical done.
-The American Urogynecology Society’s 6 steps for basic evaluation of women with SUI symptoms before primary midurethral sling discussed with patient: 1) History, 2) UA, 3) Physical examination, 4) Demonstration of stress incontinence, 5) Assessment of urethral mobility, and 6) Measurement of postvoid residual urine volume.
-UA to r/o infection.
-Conservative tx: 1) Pelvic muscle exercises (Kegel’s) with or without physical therapy, 2) behavioral modification, 3) Continence support pessaries, and 4) Urethral inserts.
-Surgical tx: Refer to Urogynecology for surgery (midurethral sling) if conservative tx is unsatisfactory. Urogyn to assess for complicated vs. uncomplicated SUI and consider multichannel urodynamic testing and other diagnostics before surgery when necessary.
Patient education:
-“SUI affects about 15.7% of adult women. Of women with SUI, 77.5% report their symptoms to be bothersome, and of this group, 28.8% report their symptoms to be moderately to extremely bothersome. The degree of bother is associated with the severity of SUI.” ACOG
Assessment of Urethral Mobility
-“Anti-incontinence surgery is more successful in women with urethral mobility, defined as a 30 degree or greater of displacement from the horizontal when the patient is in a supine lithotomy position and straining. The presence of urethral mobility indicates uncomplicated stress urinary incontinence (SUI). Lack of urethral mobility is associated with a 2.9 fold increase in the failure rate of mid-urethral sling treatments of SUI. The cotton swab test has been the traditional assessment of urethral mobility, but other methods of evaluating urethral mobility include measurement of point Aa of the POP Quantification system, visualization, palpation, and ultrasonography. Patients who lack urethral mobility may be better candidates for urethral bulking agents rather than sling or retropubic anti-incontinence procedures.” ACOG
References
http://emedicine.medscape.com/article/452289-workup
ACOG.org, Committee Opinion, Evaluation of Uncomplicated Stress Urinary Incontinence in Women Before Surgical Treatment.