Physicians do not need to perform preoperative urodynamic testing, or bladder test functioning, on patients with uncomplicated stress urinary incontinence (SUI) before having surgery to implant a bladder sling to treat symptoms because doing so does not improve surgical outcomes, according to first-time guidelines from the American College of Obstetricians and Gynecologists and the American Urogynecologic Society. Instead, the two medical groups recommend that physicians perform a basic six-step evaluation on women with uncomplicated SUI.
This is the first time guidelines have been established to provide consistency in the evaluation of uncomplicated SUI, setting standards for physicians before they operate on patients.
Urodynamic testing can cost upwards of a thousands dollars and medical experts say performing the test has not shown to offer patients any benefit. Instead, the professional groups say that physicians treating women with uncomplicated SUI, prior to bladder sling surgery, should:
* collect urologic, medical, neurologic and medication history;
* conduct a urinalysis to rule out urinary tract infection;
* perform a physical exam to investigate underlying factors;
* conduct a cough stress test to demonstrate SUI;
* perform a urethral mobility assessment to determine the likelihood of success from anti-incontinence surgery; and
* gather a measurement of postvoid residual urine volume to identify any bladder-emptying abnormalities or other issues.
Bladder slings, also known as transvaginal mesh or vaginal mesh, are a type of surgical mesh that is implanted through the vagina to hold up organs that have dropped, putting pressure on the bladder and causing symptoms such as incontinence and discomfort. The Food and Drug Administration (FDA) recently warned that complications with bladder slings were not uncommon and in some cases the mesh has eroded into the body causing chronic pain, infections, incontinence, bleeding and disability.
In some cases, multiple surgeries were required to remove the mesh, and some women have suffered lifelong complications.
Source: ObGyn News