Abstract
There have been several recent developments in surgical treatments for male and female incontinence. This article reviews the current options for treatments of urge and stress incontinence in men and women. Treatments for urge incontinence discussed include intradetrusor onabotulinum toxin A, sacral neuromodulation and percutaneous tibial nerve stimulation. For stress incontinence, suburethral mesh, bulking agents, autologous slings, colposuspension, male slings and artificial urinary sphincters are assessed.
Highlights
Urinary incontinence is defined by the International Continence Society as any involuntary leak of urine[1]
Onabotulinum toxin A Injection of onabotulinum toxin A (oBTXA), a potent neurotoxin, into the bladder wall is recommended for use in patients who have overactive bladder syndrome (OAB) with or without Urge urinary incontinence (UUI) and who have failed to respond to conservative and drug treatments
National Institute for Health and Clinical Excellence (NICE) guidelines recommend offering Sacral neuromodulation (SNM) to patients if they have not responded to conservative management, including drugs, and they are unable to perform clean intermittent catheterisation whereas European Association of Urology (EAU) guidelines recommend offering SNM to patients who have UUI refractory to anticholinergic therapy[6,7]
Summary
Urinary incontinence is defined by the International Continence Society as any involuntary leak of urine[1]. When patients are resistant to or cannot tolerate both conservative and pharmacological treatment, surgical techniques such as intravesical onabotulinum toxin A (oBTXA), sacral neuromodulation, and posterior tibial nerve stimulation are third-line options. Onabotulinum toxin A Injection of oBTXA, a potent neurotoxin, into the bladder wall is recommended for use in patients who have OAB with or without UUI and who have failed to respond to conservative and drug treatments. NICE guidelines recommend offering SNM to patients if they have not responded to conservative management, including drugs, and they are unable to perform clean intermittent catheterisation (that is, they would be unsuitable for oBTXA) whereas EAU guidelines recommend offering SNM to patients who have UUI refractory to anticholinergic therapy[6,7]. Long-term data for PTNS are sparse; most studies provide data to 12 weeks only and use varying definitions of success
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