SUI CLINICAL CARE PATHWAY Alexandra Rogers MD Sansum

SUI CLINICAL CARE PATHWAY Alexandra Rogers MD Sansum Clinic Urology Initial Office Evaluation for SUI • Stress Urinary Incontinence (SUI): • Leakage with sudden bladder pressure (i. e. cough, sneeze, brisk movement, exercise & heavy lifting) • Overactive bladder (OAB) • Strong urge to go to the bathroom • Frequent bathroom trips (>10/day) • Nocturia (waking up at night to pee) • Urge incontinence (leakage with urge/without warning) • If OAB symptoms are more bothersome these should be managed first with the OAB Clinical Care Pathway* Conservative Treatments • Fluid Reduction, Timed Voiding, Physical Therapy Re-Evaluation in the Office @ 4 to 8 Weeks • Assess change in Bladder Symptoms • Decide on Therapy Plan for SUI • Consider Urodynamic Testing prior to an intervention • Schedule Bulkamid Therapy if appropriate Bulkamid Therapy (FDA Approval Jan 2020) • The injection of a soft gel (the size of a pea) into 3 or 4 locations in the urethral wall using a small telescope • Procedure done in the ASC with light pain relief • Bulkamid is a water based soft gel’ (97. 5% water) • Safely used in plastic surgery for over 10 years • 80% of patients cured or improved at 7 years • 66% dry rate • 0% Serious complications Bulkamid Therapy • Reinjection if needed *OAB Symptoms Bothersome Urge Incontinence, Urgency, Frequency& Nocturia • OAB Clinical Care Pathway* • 1 st Line: Behavioral Changes, Pelvic PT • 2 nd Line: OAB medications • Pending Approval: e. Coin tibial implant • 3 rd Line: Botox, SNM & PTNS *See Separate OAB Pathway (on back) Glossary • • Urethra: the tube that urine comes out of • Bladder: holds urine between urinations • ASC: outpatient surgery center Sling Procedure for SUI (Surgical) • Mesh foreign body surgically placed in the vagina to support the urethra • Sling supports bladder like a hammock • Risks: extrusion, erosion, difficulty emptying & pain