Female pelvic medicine & reconstructive surgery (FPMRS) challenges on behalf of the collaborative research in pelvic
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Female pelvic medicine & reconstructive surgery (FPMRS) challenges on behalf of the collaborative research in pelvic surgery consortium (CoRPS): managing complicated cases series 7: can fibroids worsen incontinence? Sarah J. Weingarten 1 & Alex Digesu 2 & Markus Huebner 3 & Lynsey Hayward 4 & Tanaka Dune 5 & Ladin A. Yurteri-Kaplan 6 & Emily Weber LeBrun 7 & Cara L. Grimes 8 Received: 11 August 2020 / Accepted: 27 September 2020 # The International Urogynecological Association 2020
Abstract This case presents the work-up and management of a patient with a fibroid uterus and urinary incontinence. Five international experts also provide their evaluation and approach to this case. According to the literature, there is uncertainty surrounding the relationship between fibroids and urinary incontinence. The experts emphasize patient counseling and a staged approach. Keywords Urinary incontinence . Fibroids
Case A 42 year-old para 2 with fibroids presented with complaints of bulk symptoms and urinary leakage for many years. Examination and an ultrasound revealed a 20-cm uterus due to multiple fibroids, including an 18-cm fundal fibroid. The patient’s main concern was that her growing fibroids were impacting her continence. She had undergone a prior hysteroscopy with TruClear (Medtronic, Minneapolis, MN) resection of a 3-cm fundal submucosal fibroid and 2-cm right submucosal fibroid a year ago, with improvement in menorrhagia but no noted effect on incontinence. She desired definitive surgical management of her fibroids with a hysterectomy. She has mixed
* Sarah J. Weingarten [email protected] 1
2
Department of Obstetrics and Gynecology, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA Department of Obstetrics and Gynecology and Urogynecology, St. Mary’s Hospital, London, UK
3
Women’s Center Bern, Lindenhofgruppe, Bern, Switzerland
4
Department of Urogynecology, Middlemore Hospital, Auckland, New Zealand
urinary incontinence, urinary urgency incontinence (UUI) predominant. On examination, a large quantity of urine leakage was demonstrated with a positive cough stress test. She was started on a trial of tolterodine. She noted 40% improvement in her urgency and leakage symptoms. UDS revealed a maximum cystometric capacity of 272 with normal bladder compliance and normal sensations. Detrusor overactivity (DO) was present with incontinence, and terminal DO was noted. Urodynamic stress urinary incontinence (SUI) was not demonstrated. She was counseled that a hysterectomy might not cure or even affect her incontinence but she desired to proceed despite this information. How would you proceed?
5
Pelvic Floor Unit, The Royal Women’s Hospital, Parkville, Victoria, Australia
6
Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
7
Department of Obstetrics and Gynecology, University of Florida Health, Gainesville, FL, USA
8
Department of Obstetrics and Gynecology and Urology, New York Medical College, Valhalla, NY, U
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