Surgical management of stress urinary incontinence

Women are seeking treatment for stress urinary incontinence more readily due to increasing awareness of minimally invasive surgical solutions and greater expectations of pelvic floor health with advancing age. Surgery for stress urinary incontinence should only be undertaken in women following a comprehensive assessment and when conservative treatments have failed. The current evidence favours a retropubic mid-urethral tape procedure using the bottom-up approach, or colposuspension. At present there is not enough long term data on the transobturator tape technique, however, short-term data show equal efficacy as the retropubic tape. Pubovaginal slings using autologous rectus sheath fascia have the highest success rate, but also have significantly higher incidence of operative morbidity and voiding problems. Urethral bulking agents are a safe alternative, especially in those women where more invasive surgery is not desired. It is important to counsel that they have a lower success rate and repeat injections are often needed.