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. Concerns have been raised regarding the safety of tape procedures and clinicians need to be aware of the recent guidance published on this by the MHRA. Surgery for stress urinary incontinence should only be undertaken in women following a comprehensive assessment and when conservative treatments have failed after a multidisciplinary team discussion. The current evidence favours a retro-pubic mid-urethral tape procedure using the bottom-up approach, or colposuspension. Pubo-vaginal slings using autologous rectus sheath fascia have a good 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.