From the Research
The next best step for a patient with urinary incontinence and a scarred, open proximal urethra is to refer them for a surgical consultation, specifically for urethroplasty. Before the surgery, a comprehensive urological evaluation should be conducted, including urodynamic studies and imaging of the urinary tract, as recommended by recent guidelines 1. This evaluation will help determine the extent of the urethral damage and guide the surgical approach. Urethroplasty is recommended because it directly addresses the structural issue of the scarred and open proximal urethra, which is likely the root cause of the incontinence. Some studies have suggested alternative surgical approaches, such as open retropubic colposuspension 2 or the use of suburethral slings, but these may not be as effective in addressing the specific issue of a scarred and open proximal urethra. In contrast, urethroplasty has been shown to be an effective treatment for urinary incontinence due to urethral damage, with the goal of reconstructing the damaged portion of the urethra and potentially restoring normal urinary function and continence 3. The specific technique used during urethroplasty will depend on the findings from the pre-surgical evaluation, but may involve grafting or flap techniques to repair the urethral defect. This approach is preferred over more conservative treatments because the severity of the urethral damage suggests that non-surgical interventions are unlikely to provide significant improvement in this case. Key considerations in the management of urinary incontinence include a thorough evaluation, patient education, and a tailored treatment approach, as outlined in recent guidelines and reviews 1, 4, 3. Ultimately, the decision to proceed with urethroplasty should be made in consultation with a qualified urologist, taking into account the individual patient's needs and circumstances.