Urogynecological Risk Assessment in Postmenopausal Women

Niladri Sengupta; Timothy Hillard

Disclosures

Expert Rev of Obstet Gynecol. 2013;8(6):625-637. 

In This Article

Five-year View

The anticipated results of several studies have the potential to influence our practices in the coming years.

The Vault or Uterine prolapse study Evaluation (VUE Study) comprises two randomized controlled trials that compare removal of uterus versus uterine preservation, in women with uterine prolapse, and vaginal versus abdominal vault suspension, in women with vault prolapse, which is expected to influence choice of surgery by indicating which surgery is most efficacious and safest.

The use of urodynamics to diagnose the type of urinary incontinence has been a standard investigation in secondary care for many years. However, limitations in reproducing the actual symptoms and variability of interpretation are well-acknowledged. It is hoped that ongoing trials (VUSIS-2 and INVESTIGATE-2) will help to define the role of urodynamics in the future.

The bladder ultrasound study (BUS) trial aims to test the effectiveness of ultrasound measurement of bladder wall thickness in diagnosing overactive bladder. If it is found to be effective, ultrasound can be a cheaper and less-invasive alternative to urodynamics for diagnosis of OAB.

It is expected that the next 5 years will see increasing use of robotic surgery and laparoscopy in the field of pelvic reconstructive surgery. It is hoped that these new modalities will be properly evaluated before their widespread introduction.

In the field of OAB management newer drug delivery systems (such as intravesical) have the potential to minimize the side effects of anti-muscarinic drugs. Chemical denervation with intravesical capsaicin and resiniferatoxin in cases of neurogenic OAB shows encouraging results but is still undergoing evaluation.

The potential of stem cells for the management of SUI has generated considerable anticipation. The stem cells are derived from various sources: (autologous adipose-derived, muscle-derived or from human amniotic fluid) and are injected into the mid-urethral rhabdosphincter under ultrasound guidance to enable regenerative repair and to restore continence. It is hoped that the next 5 years will see more comprehensive clinical trials investigating this exciting development.

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