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Diagnosis and Surgical Treatment of Stress Urinary Incontinence

Garely, Alan D. MD; Noor, Nabila MD

doi: 10.1097/AOG.0000000000000514
Contents: Clinical Expert Series
Expert Discussion
Spanish Translation

Stress urinary incontinence (SUI) is a major problem affecting more than 20% of the nation's female population, with increasing prevalence as our population continues to age. Incontinence places a great burden on individuals, and the economic effect is large. Stress urinary incontinence occurs when there is involuntary leakage of urine during coughing, laughing, sneezing, or physical activity. It can be diagnosed during physical examination and by using low-cost office diagnostics. Although nonsurgical treatments provide some benefit, surgical interventions have demonstrated superiority with respect to subjective and objective cure and better long-term improvement. Corrective surgeries for SUI can be grouped into four categories: 1) slings (midurethral slings and slings placed at the ureterovesical junction), 2) retropubic urethropexy, 3) urethral bulking agents, and 4) artificial sphincters. The success and failure of each approach needs to be assessed in the context of individual patients and their circumstances. Slings and retropubic urethropexy are considered first-line surgical options. Since the advent of minimally invasive retropubic midurethral slings such as the tension-free vaginal tape, transobturator tension-free vaginal tape, and single-incision sling, retropubic urethropexy have fallen out of favor. Warnings about mesh use may contribute to a resurgence of retropubic urethropexy procedures such as the Burch procedure. A Burch procedure should still be considered for patients who have an aversion to mesh or if they are undergoing concurrent abdominal approach surgery. Urethral bulking agents are usually reserved for patients with a fixed, nonmobile urethra who cannot tolerate an operative experience or have failed previous antiincontinence procedures. Artificial sphincters should be considered an operation of last resort.

Stress urinary incontinence can be treated successfully with different surgical options, which can be tailored to the individual patient.Supplemental Digital Content is Available in the Text.

Department of Obstetrics and Gynecology, South Nassau Communities Hospital, Oceanside, and the Department of Obstetrics, Gynecology, and Reproductive Science, The Icahn School of Medicine at Mount Sinai, New York, New York.

Corresponding author: Alan D. Garely, MD, Chair of Obstetrics and Gynecology, South Nassau Communities Hospital, One South Central Avenue, Valley Stream, NY 11580; e-mail:

Continuing medical education for this article is available at

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists.