2026 Urogynecology for the Advanced Practice Provider-Fixing the Leak: Case-based Management of SUI and Post-procedure Complications

Video Transcription

Video Summary

The lecture focused on evaluating and treating female stress urinary incontinence (SUI), defined as leakage with increased intra-abdominal pressure such as coughing, sneezing, exercise, or intercourse. Diagnosis is primarily clinical, using history, exam, and a cough stress test; testing is usually unnecessary unless the picture is unclear or there are complicating factors.<br /><br />Treatment options were presented as a ladder: bladder training, weight loss, pelvic floor muscle therapy, vaginal estrogen, pessaries, urethral bulking, and midurethral sling surgery. Pelvic floor therapy and bladder training can meaningfully reduce leakage. Weight loss improves symptoms, especially in obese patients. Vaginal estrogen may help, while systemic/oral estrogen can worsen incontinence.<br /><br />Pessaries can be effective for episodic leakage and are useful for patients avoiding surgery. Urethral bulking is less effective than slings but has faster recovery and can be ideal for short-term goals or patients avoiding mesh. Midurethral slings offer the highest cure rates, but patients should be counseled about risks including retention, overactive bladder symptoms, mesh exposure, pain, and infection.<br /><br />Post-procedure complications were reviewed in detail, especially urinary retention after sling or bulking, and mesh exposure years later. Management depends on symptoms, post-void residual, and exam findings.

Asset Subtitle

A case-based session focusing on the diagnosis of stress urinary incontinence, treatment options and post-treatment troubleshooting. By the end of this session, you will be able to

Confidently diagnosis urinary stress incontinence.
Counsel patients on appropriate non-surgical and surgical treatment options.
Identify common post-intervention complications and initiate appropriate management plans.

Speaker: Kate Woodburn, MD

Keywords

stress urinary incontinence

cough stress test

pelvic floor muscle therapy

vaginal estrogen

pessary

urethral bulking

midurethral sling