Biology, 06.03.2020 08:22 jaimefashion12
A 60-year-old G4P4 woman presents with a two-year history of urine leakage with activity such as coughing, sneezing and lifting. Her past medical history is significant for vaginal deliveries of infants over 9 pounds. She had a previous abdominal hysterectomy and bilateral salpingo-oophorectomy for uterine fibroids. She is on vaginal estrogen for atrophic vaginitis. Physical exam shows no anterior, apical or posterior wall vaginal prolapse. Vagina is well-estrogenized. Post-void residual was normal. Q-tip test showed a straining angle of 60 degrees from the horizontal. Cough stress test showed leakage of urine synchronous with the cough. Cystometrogram revealed the absence of detrusor instability. The patient failed pelvic muscle exercises and was not interested in an incontinence pessary. Which of the following is the best surgical option for this patient?A. Retropubic urethropexyB. Needle suspensionC. Anterior repairD. Urethral bulking procedureE. Colpocleisis
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