FEMALE STRESS URINARY-INCONTINENCE CLINICAL GUIDELINES PANEL SUMMARY REPORT ON SURGICAL-MANAGEMENT OF FEMALE STRESS URINARY-INCONTINENCE

Purpose: The American Urological Association convened the Female Stres s Urinary Incontinence Clinical Guidelines Panel to analyze the litera ture regarding surgical procedures for treating stress urinary inconti nence in the otherwise healthy female subject and to make practice rec ommendations based on the treatment outcomes data. Materials and Metho ds: The panel searched the MEDLINE data base for all articles through 1993 on surgical treatment of female stress urinary incontinence. Outc omes data were extracted from articles accepted after panel review. Th e data were then meta-analyzed to produce outcome estimates for altern ative surgical procedures. Results: The data indicate that after 48 mo nths retropubic suspensions and slings appear to be more efficacious t han transvaginal suspensions, and also more efficacious than anterior repairs. The literature suggests higher complication rates when synthe tic materials are used for slings. Conclusions: The panel found suffic ient acceptable long-term outcomes data (longer than 48 months) to con clude that surgical treatment of female stress urinary incontinence is effective, offering a long-term cure in a significant percentage of w omen. The evidence supports surgery as initial therapy and as a second ary form of therapy after failure of other treatments for stress urina ry incontinence. Retropubic suspensions and slings are the most effica cious procedures for long-term success (based on cure/dry rates). Howe ver, in the panel's opinion retropubic suspensions and sling procedure s are associated with slightly higher complication rates, including lo nger convalescence and postoperative voiding dysfunction.