Surgical Treatment

The sling procedure is the primary form of open surgical treatment in women with stress incontinence. Several variations of the procedure exist with relation to the exact location of the sling and the nature of the graft material used to make the sling. The principal function of the sling is to increase the outlet resistance and thus prevent urine leakage during periods of increased intra-abdominal pressure. Initial success rates for the sling procedure range from 80% to 90% but

The complete reference list is available online at www.expertconsult.com.

www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hsahcpr&part=A5124 Agency for Health Care Policy and Research (AHCPR) Treatment of Pressure Ulcers Guideline. www.npuap.org

National Pressure Ulcer Advisory Panel. Provides up-to-date information on the prevention and management of pressure ulcers.

www.fammed.wisc.edu/ our-department/ media/ 615/geriatric-assessment Geriatric Assessment Podcast. An overview of geriatric assessment in the office setting.www.youtube.com/user/WIFamilyMedicine#p/u/4 3/xIMJ1aVvch8 Elder Abuse Podcast. An overview of the assessment and management of elder abuse.

decrease with time. Some women respond to other forms of therapy or elect to undergo another sling procedure (Anger et al., 2007).

Periurethral injection of bulking agents can be an effective treatment is some elderly women with stress incontinence. The procedure is minimally invasive and can be performed in the outpatient setting with rapid recovery and immediate results. To date, there is limited evidence that this can relieve stress incontinence in women (Keegan et al., 2007). One disadvantage is that treatment usually needs to be repeated with time. Injection therapy may be particularly useful in elderly women who are unable to undergo the more invasive sling procedure or who are symptomatic after a previous sling procedure. Older men with mild postprostatectomy stress incontinence may benefit from periurethral injection of bulking agents (Fantl et al., 1996).

KEY TREATMENT

Pelvic floor exercises help with all types of urinary incontinence in women (Hay-Smith and Dumoulin, 2006) (SOR: A). Anticholinergic drugs are effective for overactive bladder syndrome, but are associated with common side effects (Alhasso et al., 2006) (SOR: A).

There is limited evidence that periurethral injection helps women with stress incontinence (Keegan et al., 2007) (SOR: A).

Administration on Aging. Offers comprehensive information about "seniors," including aging statistics and government programs. www.ncea.aoa.gov/NCEAroot/Main_Site/Index.aspx

National Center on Elder Abuse. Provides information on the prevention, diagnosis, and management of elder abuse, including available resources for physicians, patients, and families.

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