Care Pathway for the Management of Stress Urinary Incontinence (SUI)

* Grades of Recommendation

This pathway is adapted from UroGynaecological Society of Australasia (UGSA) Surgical treatment of SUI pathway (2016)

The Grade of Recommendation has been derived from the 5th International Consultation on Incontinence (see Int Urogynecol J. 2013 Nov;24(11):1781 https://link.springer.com/article/10.1007/s00192-013-2168-x and expert opinion during the Commission’s development of the guidance

	GoR*
May be a useful option for recurrent SUI with a well supported urethra	B
Greater symptomatic improvement was observed with surgical treatments, although the advantage needs to be balanced against risk of intervention	C
Consider in women wishing to avoid mesh‐related complications	-

* Grades of Recommendation

This pathway is adapted from UroGynaecological Society of Australasia (UGSA) Surgical treatment of SUI pathway (2016)

The Grade of Recommendation has been derived from the 5th International Consultation on Incontinence (see Int Urogynecol J. 2013 Nov;24(11):1781 https://link.springer.com/article/10.1007/s00192-013-2168-x and expert opinion during the Commission’s development of the guidance

	GoR*
Inferior outcomes to pubovaginal slings for primary repair, possibly with less voiding dysfunction	B
Outcomes similar or slightly less than synthetic MUS however longer operating time and recovery, slower return to activities of daily living and more prolapse in medium term	B
Laparoscopic approach when performed same technique as open has similar success rate with less morbidity than open approach	B
Lower rates of success, with higher retreatment rates, when compared to pubovaginal slings for primary repair	B
Consider in women wishing to avoid mesh‐related complications	-

* Grades of Recommendation

This pathway is adapted from UroGynaecological Society of Australasia (UGSA) Surgical treatment of SUI pathway (2016)

The Grade of Recommendation has been derived from the 5th International Consultation on Incontinence (see Int Urogynecol J. 2013 Nov;24(11):1781 https://link.springer.com/article/10.1007/s00192-013-2168-x and expert opinion during the Commission’s development of the guidance

Pubovaginal (fascial) sling	GoR*
Similar success rates compared to MUS with longer operating time and possibly higher voiding dysfunction; fascial sling has lower rates of chronic pelvic pain, no risk of erosion or extrusion, and higher rates of post‐operative morbidity	B
Lower rate of bladder perforation during surgery compared to MUS.	B
Fascial sling has higher patient satisfaction and treatment success compared to colposuspension	B
Involves a longer operation, post‐operative hospital stay (2–3 days) and recovery period than MUS	B
Consider in women wishing to avoid mesh‐related complications	-

* Grades of Recommendation

This pathway is adapted from UroGynaecological Society of Australasia (UGSA) Surgical treatment of SUI pathway (2016)

The Grade of Recommendation has been derived from the 5th International Consultation on Incontinence (see Int Urogynecol J. 2013 Nov;24(11):1781 https://link.springer.com/article/10.1007/s00192-013-2168-x and expert opinion during the Commission’s development of the guidance

Retropubic versus transobturator mid-urethral sling	GoR*
In the short‐term there are similar success rates for retropubic and transobturator mid urethral slings	A
Obturator tapes are slightly quicker, with less blood loss, bladder perforation and voiding dysfunction difficulties. Most of these differences were small and the complications are readily able to be managed.	A
However in the medium term (>5 years) the reoperation for recurrent SUI greater in obturator group and a small number developed groin pain (3-4%) that is difficult to treat.	B
Retropubic considered as the preferred procedure with transobturator reserved for those patients with a hostile abdomen	C

* Grades of Recommendation

This pathway is adapted from UroGynaecological Society of Australasia (UGSA) Surgical treatment of SUI pathway (2016)

The Grade of Recommendation has been derived from the 5th International Consultation on Incontinence (see Int Urogynecol J. 2013 Nov;24(11):1781 https://link.springer.com/article/10.1007/s00192-013-2168-x and expert opinion during the Commission’s development of the guidance

Retropubic versus transobturator mid-urethral sling	GoR*
In the short-term there are similar success rates for retropublic and transobturator	A
Obturator tapes slightly quicker, with less blood loss, bladder perforation and voiding dysfunction difficulties. Most of these differences were small and the complications are readily able to be managed.	A
However in the medium term (>5 years) the reoperation for recurrent SUI greater in obturator group and a small number developed groin pain (3-4%) that is difficult to treat.	B
Retropubic considered as the preferred procedure with transobturator reserved for those patients with a hostile abdomen	C

* Grades of Recommendation

This pathway is adapted from UroGynaecological Society of Australasia (UGSA) Surgical treatment of SUI pathway (2016)

The Grade of Recommendation has been derived from the 5th International Consultation on Incontinence (see Int Urogynecol J. 2013 Nov;24(11):1781 https://link.springer.com/article/10.1007/s00192-013-2168-x and expert opinion during the Commission’s development of the guidance

	GoR*
The most extensively researched option for SUI establishing efficacy and safety profile	A
As effective or more effective than colposuspension or pubovaginal sling with less perioperative and post-operative morbidity	B
Recommended surgical treatment female SUI	C