Surgical treatment of urinary incontinence

Surgery for stress urinary incontinence is a commonly performed procedure. Thorough preoperative assessment, counselling and selection of the appropriate procedure are essential to a good surgical outcome. In the surgical treatment of stress urinary incontinence, evidence favours either a retropubic type 1 mesh mid-urethral tape using the bottom-up approach, or colposuspension. Data supporting the use of the transobturator technique for the insertion of a mid-urethral tape is emerging. The complications of the retropubic and transobturator tapes differ. Intraurethral bulking agents are associated with few complications but have poorer efficacy and often require repeated injections. Artificial urinary sphincters and urinary diversion are indicated only when other operations have failed. Augmentation cystoplasty for the treatment of urge incontinence is now less commonly performed due to the new modalities of sacral neuromodulation and botulinum A toxin. However, long-term data on the safety and outcome of these new treatments are awaited.