Ginekologia Polska

2021, vol. 92, no. 11, 822–828

Copyright © 2021 Via Medica
R ECCO MENDATIO NS ISSN 0017–0011, e-ISSN 2543–6767

DOI 10.5603/GP.a2021.0206

Urogynecology Section of the Polish Society of

Gynecologists and Obstetricians
guidelines on the management of stress urinary
incontinence in women
Klaudia Stangel-Wojcikiewicz1 , Artur Rogowski2,3 , Tomasz Rechberger4 ,
Wlodzimierz Baranowski5, Magdalena E. Grzybowska6 , Tomasz Kluz7 ,
Elzbieta Narojczyk-Swiesciak8 , Edyta Wlazlak9 , Bartlomiej Burzynski10 ,
Grzegorz Surkont9
1Department of Gynecology and Oncology, Jagiellonian University Medical College, Cracow, Poland

2Department of Gynecology, „Inflancka” Specialist Hospital, Warsaw, Poland

3Collegium Medicum, Cardinal Stefan Wyszynski University, Warsaw, Poland

4II Department of Gynecology, Medical University of Lublin, Poland

5Department of Gynecology, Gynecological Oncology, Military Medical Institute, Warsaw, Poland

6Department of Gynecology, Gynecological Oncology and Gynecological Endocrinology, Medical University of Gdansk, Poland

7Clinic of Gynecology and Obstetrics, Institute of Medical Science, College of Medical Science, University of Rzeszow, Poland

8II Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Bielanski Hospital Warsaw, Poland

9Department of Operative Gynecology and Gynecological Oncology, I Department of Gynecology and Obstetrics,

Medical University of Lodz, Poland

10Department of Rehabilitation, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, Poland

ABSTRACT
Objectives: The aim was to present an interdisciplinary Guideline of the Urogynecology Section of the Polish Society of
Gynecologists and Obstetricians (PSGO) for the management of stress urinary incontinence (SUI).
Material and methods: A review of the literature, including current international guidelines and earlier recommendations
of the PSGO Urogynecology Section, about the treatment of SUI was conducted.
Results: Management of SUI is presented. Four lines of therapy were identified: line 1 — the so-called ‘conservative treat-
ment’, which should always be attempted, regardless of SUI symptom severity; line 2 — surgical intervention; lines 3 and
4 — reoperations after unsuccessful surgeries from line 2. The literature reports which provided supporting evidence for
this Guideline, including the practical aspects, were discussed.
Conclusions: A systematic review of the guidelines and an analysis of SUI management were conducted. The need for
an individualized approach was emphasized.
Key words: urinary incontinence, stress urinary incontinence, conservative treatment, physiotherapy, surgical treatment,
midurethral sling, colposuspension
Ginekologia Polska 2021; 92, 11: 822–828

Corresponding author:
Magdalena E. Grzybowska
Department of Gynecology, Gynecological Oncology and Gynecological Endocrinology, Medical University of Gdansk, 17 Smoluchowskiego St, 80-214 Gdansk, Poland
e-mail: [email protected]

Received: 20.09.2021 Accepted: 26.09.2021 Early publication date: 10.11.2021

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download
articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

822
 Klaudia Stangel-Wojcikiewicz et al., Guideline on the management of stress urinary incontinence in women

INTRODUCTION 4. physiotherapy;
Stress urinary incontinence (SUI) is defined as involun- 5. supportive devices: pessaries, vaginal tampons;
tary leakage of urine on effort or exertion, or with coughing 6. pharmacotherapy.
or sneezing [1, 2]. SUI affects a significant number of women
and negatively impacts their quality of life. As many as 75% Second-line treatment: first-line surgical
of older, 44–57% of middle-aged, and 25% of young women interventions
report symptoms of urinary incontinence [3]. If the conservative therapy proves ineffective or the
physical examination reveals high-grade urinary incon-
Objectives tinence, with unfavorable prognosis after conservative
The aim of this publication was to develop a Guideline management, second-line treatment, i.e., surgery, is rec-
for the management of stress urinary incontinence, based ommended.
on the available literature, expert knowledge, and everyday A. MUS (midurethral sling) procedure, during which the
practice. sling is placed in the middle part of the urethra, or retropubic
colposuspension (Burch) are the most common first-line
MATERIAL AND METHODS surgical treatments.
In 2005, 2006 and 2010, the expert panel of the Polish So- B. If the tape surgery proves unsuccessful, implant re-
ciety of Gynecologists and Obstetricians (PSGO) developed moval and the insertion of a new tape is recommended.
guidelines for the diagnosis and treatment of urogynecologic Some specialists suggest to perform Burch colposuspension
conditions. The present publication is an update of those in such cases. In patients with persistent SUI symptoms
recommendations, based on the literature reports published after Burch colposuspension, MUS may be considered [5–7].
between 2010 and 2019, as well as the recommendations
of the American Urological Association, the International Third-line treatment: second-line surgical
Urogynecology Association, the European Association of interventions
Urology, and the Canadian Urological Association [4]. If first-line surgical treatment (usually after both surger-
The literature about the management of SUI, including ies) proved ineffective or in selected cases, the following are
the current international guidelines, was reviewed. Special used as second-line surgery:
attention has been paid to the level of evidence and degree a) urethral bulking agents
of recommendation of the available data sources. If the b) autologous pubovaginal sling
literature source seemed insufficient, expert opinions and
management protocols were included. Fourth-line treatment: third-line surgical
interventions
GUIDELINES If the first- and second-line surgical interventions prove
First-line treatment: non-surgical treatment ineffective, an artificial urethral sphincter and an adjustable
At the first stage of the treatment, it is important to compression device may be considered in selected cases.
inform the patient about the details of the management
which aims to minimize the discomfort associated with OVERVIEW OF THE RECOMMENDATIONS
urinary incontinence, i.e. the smell of urine, skin irritation The literature offers a number of effective therapies for
due to prolonged exposure to urine, and the feeling of loss SUI, including various types of non-surgical and surgical
of control over one’s body. The use of personal hygiene treatments. Conservative management should be the first
products such as pads and sanitary towels is recommended. stage of SUI therapy [8].
The choice of non-surgical methods should be tailored
to the individual needs and symptoms of the patient, and Non-surgical treatment
her ability to comply with the therapy. Patient motivation Conservative management should be attempted in
to introduce lifestyle changes and compliance positively many patients, even if surgical treatment had already been
affect treatment efficacy. planned. The effectiveness of non-surgical treatment is typi-
Among the methods of non-surgical treatment of SUI, cally evaluated after 8 to 12 weeks.
the following should be considered: The use of protective materials (high absorbency pads
1. treatment of concomitant diseases and drug modifica- and sanitary towels, intravesical catheters which allow
tion; for external urine collection) can improve the short- and
2. lifestyle modifications; long-term patient comfort [9]. Appropriate sanitary prod-
3. treatment and prevention of recurrent urinary tract ucts are well-tolerated, and women of all ages use them will-
infections; ingly. Product diversity enables the users to adjust the size

www. journals.viamedica.pl/ginekologia_polska 823

Ginekologia Polska 2021, vol. 92, no. 11

as well as the following features: absorption, odor control, There is evidence that women who do sports experience uri-
anti-allergic properties, etc. (LE 1b). nary incontinence later in life (LE 3 recommendation) [17, 18].
1. Drug modification may reduce the symptoms of SUI in Nevertheless, proper body weight and higher mobility when
patients treated for concomitant diseases, e.g., metabol- accessing the toilet are undeniable benefits of engaging in
ic syndrome, cardiovascular diseases, respiratory system regular physical activity.
diseases, chronic renal failure, degenerative syndromes, e) Smoking cessation
including multiple sclerosis, mental diseases, and de- No relationship between smoking cessation and im-
pression [10]. proved urine control has been demonstrated. However,
2. Educating the patient about lifestyle modifications often smoking-associated cough may increase the intra-abdom-
results in significant improvement. It also allows the inal pressure and intensify the symptoms of urinary incon-
patients to better understand the nature of the disease tinence [19].
and, consequently, to treat it more effectively. f ) Bladder training
a) Consumption of fluids containing caffeine or theine Controlled voiding, scheduled micturitions with gradu-
(coffee, tea, carbonated drinks) and alcohol bever- ally extended time intervals between voiding and correct
ages urination habits are elements of bladder training. These
The literature offers no evidence of a linear associa- techniques are typically used in the management of urgency
tion between caffeine intake (equivalent to one cup of cof- urinary incontinence, but they also proved to be effective
fee/day) and the prevalence and severity of urinary incon- in SUI therapy [20].
tinence. Only reduction of caffeine intake combined with 3. Comprehensive diagnosis, treatment and prevention
behavioral therapy was demonstrated to reduce urgency, of urinary tract infections are important elements of
but it did not reduce urinary incontinence as compared managing patients with lower urinary tract symptoms.
to behavioral therapy alone [11]. Therefore, lower caffeine 4. Physiotherapy.
intake does not reduce symptoms of urinary incontinence The most common physiotherapeutic methods used
(LE2). It is recommended to reduce fluid intake (including in the management of SUI in women include pelvic floor
fluids which increase diuresis) two hours before bedtime, muscle training — PFMT (the so-called ‘Kegel exercises’),
especially in patients with early morning and night urinary biofeedback, ultrasonography feedback, EMG biofeedback,
incontinence. electrostimulation (superficial, vaginal), and pelvic floor
b) Treatment of overweight and obesity manual therapy [1, 3, 4, 8, 10, 21]. Incorrect physiotherapy
Overweight and obesity are confirmed risk factors for may intensify urogynecological symptoms. Professional uro-
the development of urinary incontinence. SUI is believed gynecological physiotherapy should be initiated after the
to occur even 4.2-fold more often in obese women as com- functional diagnosis. Its effectiveness depends on therapy
pared to their normal body weight peers [12]. The loss of at duration and expert supervision over the therapeutic pro-
least 5% of the initial weight is recommended. According to cess [22]. PFMT includes different protocols and principles
NICE, weight reduction should be recommended to women of this branch of physiotherapy. Separate guidelines for
with the BMI of >30 kg/m2 [13, 14]. Even a slight reduction physiotherapeutic management of SUI in women have been
of the body weight can improve urinary continence in over- presented elsewhere.
weight and obese women [15] (LE 1a). 5. Supportive devices.
c) Treatment of constipation a) pessaries
Constipation is a common occurrence in patients with Silicone pessaries (urethra and cerclage), with a thick-
urinary incontinence. According to an observational study ening near the urethra, are usually recommended in SUI
in women with urinary incontinence, women with POP, and therapy. The desired effect is obtained when the thickening
controls, history of constipation was associated with both, of the pessary supports the transition of the bladder and
pelvic organ prolapse and urinary incontinence [16]. How- the urethra. The rim of the pessary must be sized so that
ever, no evidence supports the alleviation of SUI symptoms it does not move and rests along the posterior wall of the
after reduction of constipation (LE 4). vagina. If those pessaries prove ineffective, a cube-type
d) Physical activity pessary may be used. In such cases, the upper edge of the
Regular physical activity can positively affect pelvic floor pessary should be placed under the urethra for support and
muscles and reduce urinary incontinence episodes. Resist- urine control. A gynecological examination and adjustment
ance training with additional load, high-intensity jumping, of the material, durability, size and shape to the anatomic
e.g., trampolining, as well as high-intensity running should conditions are necessary to select the appropriate vaginal
be excluded. Various studies demonstrated elevated risk for tampon or pessary. All the measures can be used periodi-
developing SUI in active women, especially sportswomen. cally or remain the only form of conservative therapy (with

824 www. journals.viamedica.pl/ginekologia_polska

 Klaudia Stangel-Wojcikiewicz et al., Guideline on the management of stress urinary incontinence in women

the recommendation to change daily). In SUI therapy, the MUS

pessaries may be used during the day or whenever needed Currently, sling implantation under the middle part of
(LE 2a) [23–25]. the urethra is based on the use of macroporous tape (type
b) vaginal tampons 1 according to Amid's Classification) [34–37]. The tape pa-
Tampons made of special, flexible, and delicate medi- rameters allow to significantly reduce the risk of exposure
cal material — PVA (vinyl polymer-polyvinyl alcohol) in as compared to multifilament and microporous materials
the shape of a cylinder or a cube, are used in SUI therapy. (higher risk of infection). With the advancements in this area,
The tampon is inserted under the urethra for support. It is new materials will likely be used in the future. The method
recommended to use vaginal tampons only when necessary, of sling implantation has been modified: the tape can be
which might mean only during sport activities or dancing inserted from the suprapubic side down to underneath of
for some patients, or throughout the day for others [25]. the urethra (rarely used) or passed through the retropubic
6. Pharmacotherapy of SUI. or the obturator space [38]. Some studies indicated the
Duloxetine, which inhibits the presynaptic re-uptake of possibility of improved outcomes of SUI therapy after MUS
serotonin (5-HT) and norepinephrine (NE), can be used in SUI surgery if the procedure is individualized using pelvic floor
therapy. A meta-analysis of four randomized, placebo-con- sonography (PFS). The choice of the implantation site is
trolled clinical trials reported to the European Medicines determined by urethral length and mobility and the type
Agency, demonstrated that duloxetine was more effective of sling [39–43].
than placebo as far as the rates of weekly incontinence
episodes were concerned [26]. Level LE 1a recommendation Retropubic colposuspension
for duloxetine has been reported by the experts from the Colposuspension is usually performed in patients with
European Association of Urology, whereas in the USA, paravaginal lateral defect and excessive mobility of the
the FDA suspended the registration of this drug for SUI bladder neck, which causes SUI. Colposuspension may be
therapy [27]. Duloxetine is not registered for the treatment performed in patients after MUS. MUS implantation is also
of SUI in Poland (‘off label’ use). often recommended after unsuccessful colposuspension
A review of the Cochrane database and the avail- [7, 44].
able literature indicated improved continence control in Colposuspension is associated with the rate of urinary
a short-term evaluation for vaginal estrogen use (LE 1a). incontinence correction ranging from 85–90% for the
The method of application is easy and safe for the patient. follow-up (FU) of 1–5 years after surgery to 70% for FU
The degree of absorption and of systemic activity is so low of > 5 years. A comparison of colposuspension and MUS re-
that it can be used for short periods even in women after vealed no differences in the subjective or objective efficacy
breast cancer treatment. The optimal duration of the therapy of SUI therapy, regardless of the time factor [45, 46] (LE 1a).
has not been determined and should be adjusted to the Likewise, studies comparing the results of MUS from the ret-
individual needs of the patient [28–30]. ropubic versus obturator access (1–5 years FU and > 5 years
Systemic estrogen-progestogen replacement therapy FU), found no differences in the subjective recovery rate (LE
may intensify the symptoms of urinary incontinence as 1a). FU of > 5 years showed the recovery rate of 51–88% for
compared to placebo [31]. the retropubic and 43–92% for the obturator access [47].
The obturator access was associated with more frequent
Second-line treatment: first-line surgery groin pain (6.4% vs 0.6%), while the retropubic access with
First-line surgical treatment of SUI includes: midurethral a higher rate of bladder perforations (4.5% vs 0.6%), difficulty
sling, during which the sling is placed in the middle part of passing urine, and organ and vessel injury (LE 1a).
the urethra, or retropubic colposuspension (Burch).
The choice of the procedure should be tailored to the Third-line treatment: second-line surgery
individual needs of the patient, based on the symptoms a) urethral bulking agents
and diagnostic results, as well as the expert knowledge and The procedures which ‘seal’ the urethra consist in the
surgical experience of the physician. The scope of preopera- administration of bulking agents, submucosally delivered
tive diagnostics depends on the symptoms, findings of the via the transurethral or transvaginal route, which reduces
clinical examination and the additional tests, the experience the urethral lumen. The agents are typically injected into
of the physician and common practice in a given medical the submucosa surrounding the bladder neck or mid-ure-
center. It is necessary to evaluate pelvic organ prolapse and thra [48].
the possible treatment methods before or during SUI sur- Due to the variety of the available bulking agents and
gery [32, 33]. These issues have been discussed elsewhere, lack of long-term observations, it is challenging to present
in the guideline for the surgical management of POP. unequivocal guidelines for their use in SUI therapy. Only

www. journals.viamedica.pl/ginekologia_polska 825

Ginekologia Polska 2021, vol. 92, no. 11

short-term observations demonstrated improved urine con- tive treatment and personal hygiene measures have been
trol (1b) [49]. Therefore, bulking agent injection, despite exhausted and SUI persists.
being minimally invasive, should be treated as an alternative Importantly, guidelines are only an indication for the
procedure for SUI: in the next stage of treatment, in patients specialist treatment and will not replace clinical knowledge
with systemic diseases who do not want to undergo the when making individualized therapeutic decisions, which
classic procedures (2a) [50]. in some cases may prompt the experts to deviate from the
b) Autologous fascial sling, pubovaginal sling, bladder recommendations.
neck slings
This procedure uses a piece of the fascial tissue which Conflict of interest
stabilizes the urethra on the vaginal side. The most used All authors declare no conflict of interest.
sling is the autologous fascial sling, originating from
the rectus sheath or the fascia lata of the thigh. It is References
not recommended as first-line treatment and should be 1. Haylen BT, de Ridder D, Freeman RM, et al. International Urogyneco-
logical Association, International Continence Society. An International
used only in case of recurrent urinary incontinence after Urogynecological Association (IUGA)/International Continence Society
earlier procedures proved ineffective, in patients with (ICS) joint report on the terminology for female pelvic floor dysfunction.
Neurourol Urodyn. 2010; 29(1): 4–20, doi: 10.1002/nau.20798, indexed
internal sphincter deficiency, after prior radiotherapy, in Pubmed: 19941278.
MUS failure, and after urethral injury. A comparison with 2. Wlaźlak E, Surkont G, Shek KaL, et al. Can we predict urinary stress incon-
tinence by using demographic, clinical, imaging and urodynamic data?
MUS synthetic sling revealed that the procedures have
Eur J Obstet Gynecol Reprod Biol. 2015; 193: 114–117, doi: 10.1016/j.
similar efficacy [51]. Nevertheless, MUS seems to be more ejogrb.2015.07.012, indexed in Pubmed: 26291686.
beneficial considering the increased risk for postopera- 3. Bettez M, Tu LeM, Carlson K, et al. 2012 update: guidelines for adult
urinary incontinence collaborative consensus document for the cana-
tive urination disorders, abnormal wound healing, and dian urological association. Can Urol Assoc J. 2012; 6(5): 354–363, doi:
procedure duration which are associated with autolo- 10.5489/cuaj.12248, indexed in Pubmed: 23093627.
4. Nambiar AK, Bosch R, Cruz F, et al. Asociación Europea de Urología, Euro-
gous slings. pean Association of Urology. EAU guidelines on assessment and nonsurgi-
cal management of urinary incontinence. Eur Urol. 2012; 62(6): 1130–1142,
doi: 10.1016/j.eururo.2012.08.047, indexed in Pubmed: 22985745.
Fourth-line treatment: third-line surgical
5. Fabian G, Kociszewski J, Kuszka A, et al. Vaginal excision of the
treatment: artificial urinary sphincter (AUS) and sub-urethral sling: analysis of indications, safety and outcome. Arch
adjustable compression therapy (ACT) Med Sci. 2015; 11(5): 982–982, doi: 10.5114/aoms.2014.42305, indexed
in Pubmed: 26528340.
Implantation of an artificial urethral sphincter involves 6. Giarenis I, Mastoroudes H, Cardozo L, et al. What do we do when a mi-
transabdominal insertion of a system which replaces the durethral tape fails? Rediscovery of open colposuspension as a salvage
continence operation. International Urogynecology Journal. 2012; 23(8):
normal functions of a urethral sphincter. It is the final solu- 1117–1122, doi: 10.1007/s00192-012-1720-4.
tion for patients with no urine control and after other surgi- 7. Surkont G, Wlaźlak E, Petri E, et al. Standardized modified colposuspen-
sion--mid-term results of prospective studies in one centre. Ann Agric
cal procedures proved unsuccessful (LE3) [52].
Environ Med. 2015; 22(2): 293–296, doi: 10.5604/12321966.1152082,
indexed in Pubmed: 26094526.
Future course: regenerative medicine 8. Wein AJ. Committee Opinion No. 603: Evaluation of uncompli-
cated stress urinary incontinence in women before surgical treat-
Autologous muscle-derived stem cells obtained by ment. Obstet Gynecol. 2014; 123(6): 1403–1407, doi: 10.1097/01.
skeletal muscle biopsy and injected into the area of the AOG.0000450759.34453.31, indexed in Pubmed: 24848922.
9. Teunissen TAM, Lagro-Janssen ALM. Sex differences in the use of absor-
urethral sphincter were shown to be effective in Phase I/II bent (incontinence) pads in independently living elderly people: do men
trials [53–55]. Randomized phase III trials (Clinicaltrials. receive less care? Int J Clin Pract. 2009; 63(6): 869–873, doi: 10.1111/j.17
42-1241.2008.01975.x, indexed in Pubmed: 19490196.
gov Identifier: NCT01893138) are currently in progress. The
10. Sarma AV, Kanaya A, Nyberg LM, et al. Diabetes Control and Complica-
proclaimed mechanism of action consists in promoting tis- tions Trial/Epidemiology of Diabetes Interventions and Complications
sue remodeling by in situ secretion of growth factors and Research Group. Risk factors for urinary incontinence among women
with type 1 diabetes: findings from the epidemiology of diabetes inter-
cytokines, which helps to restore the sphincter structure ventions and complications study. Urology. 2009; 73(6): 1203–1209, doi:
and its function [56] (LE 4). 10.1016/j.urology.2008.11.009, indexed in Pubmed: 19362350.
11. Bryant CM, Dowell CJ, Fairbrother G. Caffeine reduction education
to improve urinary symptoms. Br J Nurs. 2002; 11(8): 560–565, doi:
SUMMARY 10.12968/bjon.2002.11.8.10165, indexed in Pubmed: 11979209.
12. Fuselier A, Hanberry J, Margaret Lovin J, et al. Obesity and stress urinary
The implementation of targeted therapeutic manage-
incontinence: impact on pathophysiology and treatment. Curr Urol Rep.
ment of SUI must be preceded by a thorough diagnostic 2018; 19(1): 10, doi: 10.1007/s11934-018-0762-7, indexed in Pubmed:
process. Details about patient eligibility and correct quali- 29468457.
13. National Collaborating Centre for Women’s and Children’s Health
fication will allow to choose the optimal treatment and (UK). Urinary Incontinence in Women: The Management of Urinary
obtain urine control. Incontinence in Women. London: Royal College of Obstetricians and
Gynecologists (UK); 2013.
Surgical intervention (tailored to the individual needs 14. Nambiar AK, Bosch R, Cruz F, et al. Asociación Europea de Urología, Euro-
of the patient) should be considered only after conserva- pean Association of Urology. EAU guidelines on assessment and nonsurgi-

826 www. journals.viamedica.pl/ginekologia_polska

 Klaudia Stangel-Wojcikiewicz et al., Guideline on the management of stress urinary incontinence in women

cal management of urinary incontinence. Eur Urol. 2012; 62(6): 1130–1142, floor ultrasound evaluation. Ginekol Pol. 2017; 88(6): 302–306, doi:
doi: 10.1016/j.eururo.2012.08.047, indexed in Pubmed: 22985745. 10.5603/GP.a2017.0057, indexed in Pubmed: 28727128.
15. Whitcomb EL, Subak LL. Effect of weight loss on urinary incontinence 34. Amid PK. Classification of biomaterials and their related complica-
in women. Open Access J Urol. 2011; 3: 123–132, doi: 10.2147/OAJU. tions in abdominal wall hernia surgery. Hernia. 1997; 1(1): 15–21, doi:
S21091, indexed in Pubmed: 24198645. 10.1007/bf02426382.
16. Kaplan SA, Dmochowski R, Cash BD, et al. Systematic review of the 35. Klinge U, Klosterhalfen B. Modified classification of surgical meshes for
relationship between bladder and bowel function: implications hernia repair based on the analyses of 1,000 explanted meshes. Hernia.
for patient management. Int J Clin Pract. 2013; 67(3): 205–216, doi: 2012; 16(3): 251–258, doi: 10.1007/s10029-012-0913-6, indexed in
10.1111/ijcp.12028, indexed in Pubmed: 23409689. Pubmed: 22562353.
17. Carvalhais A, Natal Jorge R, Bø K. Performing high-level sport is strongly 36. Surkont G, Wlaźlak E, Suzin J. Long-term risk of complications after
associated with urinary incontinence in elite athletes: a comparative mid-urethral sling IVS implantation. Ann Agric Environ Med. 2015; 22(1):
study of 372 elite female athletes and 372 controls. Br J Sports Med. 163–166, doi: 10.5604/12321966.1141388, indexed in Pubmed: 25780848.
2018; 52(24): 1586–1590, doi: 10.1136/bjsports-2017-097587, indexed 37. Kowalik CG, Dmochowski RR, De EJB. Surgery for female SUI: The
in Pubmed: 28642223. ICI algorithm. Neurourol Urodyn. 2019; 38 Suppl 4: S21–S27, doi:
18. Nygaard IE. Does prolonged high-impact activity contribute to 10.1002/nau.23879, indexed in Pubmed: 31050030.
later urinary incontinence? A retrospective cohort study of female 38. Delorme E. [Transobturator urethral suspension: mini-invasive procedure
Olympians. Obstet Gynecol. 1997; 90(5): 718–722, doi: 10.1016/S0029- in the treatment of stress urinary incontinence in women]. Prog Urol.
7844(97)00436-5, indexed in Pubmed: 9351751. 2001; 11(6): 1306–1313.
19. Hannestad YS, Rortveit G, Daltveit AK, et al. Are smoking and other 39. Wlaźlak E, Viereck V, Kociszewski J, et al. Role of intrinsic sphincter
lifestyle factors associated with female urinary incontinence? The deficiency with and without urethral hypomobility on the outcome
Norwegian EPINCONT Study. BJOG. 2003; 110(3): 247–254, indexed in of tape insertion. Neurourol Urodyn. 2017; 36(7): 1910–1916, doi:
Pubmed: 12628262. 10.1002/nau.23211, indexed in Pubmed: 28139863.
20. Fantl JA, Wyman JF, Harkins SW, et al. Bladder training in the manage- 40. Wlaźlak E, Kluz T, Kociszewski J, et al. The analysis of repeatability and
ment of lower urinary tract dysfunction in women. A review. J Am Geriatr reproducibility of bladder neck mobility measurements obtained dur-
Soc. 1990; 38(3): 329–332, doi: 10.1111/j.1532-5415.1990.tb03514.x, ing pelvic floor sonography performed introitally with 2D transvaginal
indexed in Pubmed: 2179377. probe. Ginekol Pol. 2017; 88(7): 360–365, doi: 10.5603/GP.a2017.0068,
21. Marques A, Stothers L, Macnab A. The status of pelvic floor muscle indexed in Pubmed: 28819940.
training for women. Can Urol Assoc J. 2010; 4(6): 419–424, doi: 41. Wlaźlak E, Kluz T, Surkont G, et al. Urethral funneling visualized during
10.5489/cuaj.10026, indexed in Pubmed: 21191506. pelvic floor sonography - analysis of occurrence among urogynecologi-
22. Dumoulin C, Cacciari LP, Hay-Smith EJ. Pelvic floor muscle training cal patients. Ginekol Pol. 2018; 89(2): 55–61, doi: 10.5603/GP.a2018.0010,
versus no treatment, or inactive control treatments, for urinary indexed in Pubmed: 29512808.
incontinence in women. Cochrane Database Syst Rev. 2018; 10: 42. Kuszka A, Rautenberg O, Wlaźlak E, et al. Do different vaginal tapes need
CD005654, doi: 10.1002/14651858.CD005654.pub4, indexed in different suburethral incisions? The one-half rule. Neurourol Urodyn.
Pubmed: 30288727. 2015; 34(8): 741–746.
23. Cundiff GW, Weidner AC, Visco AG, et al. A survey of pessary use by 43. Kociszewski J, Rautenberg O, Kuszka A, et al. Can we place tension-free
members of the American urogynecologic society. Obstet Gynecol. vaginal tape where it should be? The one-third rule. Ultrasound Obstet
2000; 95(6 Pt 1): 931–935, doi: 10.1016/s0029-7844(00)00788-2, indexed Gynecol. 2012; 39(2): 210–214.
in Pubmed: 10831995. 44. Surkont G, Wlaźlak E, Dunicz-Sokolowska A, et al. [The efficacy of SUI
24. Donnelly MJ, Powell-Morgan S, Olsen AL, et al. Vaginal pessaries for the treatment with Burch colposuspension evaluated with use of ITT analy-
management of stress and mixed urinary incontinence. Int Urogynecol sis]. Ginekol Pol. 2007; 78(5): 378–380, indexed in Pubmed: 17867329.
J Pelvic Floor Dysfunct. 2004; 15(5): 302–307, doi: 10.1007/s00192-004- 45. Oliveira LM, Dias MM, Martins SB, et al. Surgical treatment for stress
1163-7, indexed in Pubmed: 15300365. urinary incontinence in women: A systematic review and meta-analy-
25. Wlaźlak E, Krzycka M, Surkont G. Wysiłkowe nietrzymanie moczu-lec- sis. Rev Bras Ginecol Obstet. 2018; 40(8): 477–490, doi: 10.1055/s-0038-
zenie zachowawcze, pessaroterapia. In: Baranowski, W, Rogowski A. ed. 1667184, indexed in Pubmed: 30142667.
Uroginekologia. Medical Tribune : 254–265. 46. Asıcıoglu O, Gungorduk K, Besımoglu B, et al. A 5-year follow-up study
26. Maund E, Guski LS, Gøtzsche PC. Considering benefits and harms of comparing Burch colposuspension and transobturator tape for the
duloxetine for treatment of stress urinary incontinence: a meta-anal- surgical treatment of stress urinary incontinence. Int J Gynaecol Ob-
ysis of clinical study reports. CMAJ. 2017; 189(5): E194–E203, doi: stet. 2014; 125(1): 73–77, doi: 10.1016/j.ijgo.2013.09.026, indexed in
10.1503/cmaj.151104, indexed in Pubmed: 28246265. Pubmed: 24412004.
27. Historical information on duloxetine hydrochloride (marketed as Cym- 47. Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for
balta). Silver Spring (MD): Food and Drug Administration (US); 2013. stress urinary incontinence in women. Cochrane Database Syst Rev.
www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationfor- 2017; 7: CD006375, doi: 10.1002/14651858.CD006375.pub4, indexed
patientsandproviders/ucm114970htm (2016 May 30). in Pubmed: 28756647.
28. Cody JD, Jacobs ML, Richardson K, et al. Oestrogen therapy for urinary 48. Kuhn A, Stadlmayr W, Lengsfeld D, et al. Where should bulking agents
incontinence in post-menopausal women. Cochrane Database Syst Rev. for female urodynamic stress incontinence be injected? Int Urogynecol
2012; 10: CD001405, doi: 10.1002/14651858.CD001405.pub3, indexed J Pelvic Floor Dysfunct. 2008; 19(6): 817–821, doi: 10.1007/s00192-007-
in Pubmed: 23076892. 0535-1, indexed in Pubmed: 18157642.
29. Robinson D, Cardozo L. Estrogens and the lower urinary tract. Neuro- 49. Hegde A, Smith AL, Aguilar VC, et al. Three-dimensional endovaginal
urol Urodyn. 2011; 30(5): 754–757, doi: 10.1002/nau.21106, indexed in ultrasound examination following injection of Macroplastique for stress
Pubmed: 21661025. urinary incontinence: outcomes based on location and periurethral dis-
30. Donders GGG, Ruban K, Bellen G, et al. Pharmacotherapy for the tribution of the bulking agent. Int Urogynecol J. 2013; 24(7): 1151–1159,
treatment of vaginal atrophy. Expert Opin Pharmacother. 2019; 20(7): doi: 10.1007/s00192-012-1983-9, indexed in Pubmed: 23229417.
821–835, doi: 10.1080/14656566.2019.1574752, indexed in Pubmed: 50. Leone Roberti Maggiore U, Bogani G, Meschia M, et al. Urethral bulking
30897020. agents versus other surgical procedures for the treatment of female
31. Hendrix SL, Cochrane BB, Nygaard IE, et al. Effects of estrogen with and stress urinary incontinence: a systematic review and meta-analy-
without progestin on urinary incontinence. JAMA. 2005; 293(8): 935–948, sis. Eur J Obstet Gynecol Reprod Biol. 2015; 189: 48–54, doi: 10.1016/j.
doi: 10.1001/jama.293.8.935, indexed in Pubmed: 15728164. ejogrb.2015.03.025, indexed in Pubmed: 25855326.
32. Lemos N, Korte JE, Iskander M, et al. Center-by-center results of a mul- 51. Mahdy A, Ghoniem GM. Autologous rectus fascia sling for treatment
ticenter prospective trial to determine the inter-observer correlation of of stress urinary incontinence in women: A review of the literature.
the simplified POP-Q in describing pelvic organ prolapse. Int Urogynecol Neurourol Urodyn. 2019; 38 Suppl 4: S51–S58, doi: 10.1002/nau.23878,
J. 2012; 23(5): 579–584, doi: 10.1007/s00192-011-1593-y, indexed in indexed in Pubmed: 30525246.
Pubmed: 22083515. 52. Alonso Ro, Fes As, Fernandez Barranco L, et al. Four-year experience
33. Kluz T, Wlaźlak E, Surkont G. Transvaginal six-arm mesh OPUR in women with the flowsecure artificial urinary sphincter. Problems and solution.
with apical pelvic organ prolapse - analysis of short-term results, pelvic Neurol Urodyn. 2011; 30: 250.

www. journals.viamedica.pl/ginekologia_polska 827

Ginekologia Polska 2021, vol. 92, no. 11

53. Stangel-Wojcikiewicz K, Piwowar M, Jach R, et al. Quality of life as- Urodynamics. 2013; 33(3): 324–330, doi: 10.1002/nau.22404, indexed
sessment in female patients 2 and 4 years after muscle-derived cell in Pubmed: 23606303.
transplants for stress urinary incontinence treatment. Ginekol Pol. 2016; 55. Stangel-Wójcikiewicz K. egenerative Medicine for the Treatment of
87(3): 183–189, doi: 10.17772/gp/61330, indexed in Pubmed: 27306126. Urinary Incontinence. Jagiellonian University Press .
54. Stangel-Wojcikiewicz K, Jarocha D, Piwowar M, et al. Autologous 56. Peters KM, Dmochowski RR, Carr LK, et al. Autologous muscle derived cells
muscle-derived cells for the treatment of female stress urinary inconti- for treatment of stress urinary incontinence in women. J Urol. 2014; 192(2):
nence: A 2-year follow-up of a polish investigation. Neurourology and 469–476, doi: 10.1016/j.juro.2014.02.047, indexed in Pubmed: 24582537.

828 www. journals.viamedica.pl/ginekologia_polska