Overview of surgical practice in the treatment of urine incontinence

Introduction. Urinary incontinence (UI) in women is a hot topic among many professionals today. It is proved that mid-urethral synthetic tape is the gold standard in the treatment of UI. There has been a steady increase in the number of operations using synthetic prostheses in this category of patients since 2005. However, along with this, the number of complications after this surgical technique is also increasing. Methods for controlling the tension of the synthetic tape are still largely dependent on the experience of the surgeon and the existing traditions of the clinic.

In this regard, we conducted an anonymous survey among specialists of urogynecologists, where we found out the main opinions in the diagnosis and technique of surgical treatment of UI.

Materials and methods. Department of Urology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry has initiated a comparative observational clinical trial to assess the responses of Russian-speaking specialists of urogynecologists on the specifics of treatment of urinary incontinence in women using an anonymous online survey based on SurveyMonkey. The survey was conducted from October to December 2019 and consisted of 17 questions on various topics. Responses were analyzed using descriptive statistics.

Results. The analysis included the answers of 161 specialists (63% of urologists, 37% of gynaecologists) from 7 countries. Most specialists (47%) have little experience (up to 5 years) of surgical treatment of UI. Interest in topics and masterclasses and internships was noted by 120 respondents (76.4%). More than 80% of specialists noted that they use a urodynamic study in the diagnosis of UI. Half of the respondents used the preoperative "cough" test results to determine the tape tension. About half of the respondents noted that they use the intraoperative "cough" test, 5.8% use the Crede manoeuvre, and 10.3% use the Valsalva test. The survey showed that specialists use various surgical instruments to control the tape tension intraoperatively.

Conclusions. Our results show that among specialists in urogynecology there is a wide range of variations in the diagnosis and technique of surgical treatment of UI. Evaluation and development of synthetic methods for tension control is a hot topic that could potentially improve the patients' quality of life and the results of treatment of patients with UI.

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