Modern approaches to surgical treatment for female stress urinary incontinence

Abstract

Stress urinary incontinence (SUI) is a prevalent condition, affecting a significant proportion of women, with 13.6% requiring surgical intervention during their lifetime. Surgical treatments primarily aim to provide suburethral support or enhance urethral closure mechanisms. Traditionally, colposuspensions and autologous rectus fascial slings have been considered effective first-line surgical options for managing SUI. These procedures have shown reliable outcomes in terms of symptom relief and long-term efficacy. The use of midurethral tapes, once the most popular treatment option in the UK, is currently suspended due to the concerns about the risk of chronic pelvic pain and vaginal mesh exposure. It remains an option for women with deemed ‘exceptional circumstances’ and may be cautiously reintroduced into practice with certain prerequisites. The mesh ‘pause’ has driven a much-improved process of patient counselling, expectation setting, utilizsation of the ‘MDT’, enhanced surgical standards and data collection. It has led to a reassessment of surgical approaches. The current trend is for many women to request intra-urethral bulking (Bladder neck injection) as a first line procedure to treat primary SUI. There is a renewed focus on established methods like colposuspension, open or laparoscopic, and modified autologous fascial ‘sling on a string’. These procedures avoid mesh related risks but are associated with different risks such as new onset vaginal prolapse and post-operative voiding difficulty, respectively.