A critical overview of the evidence base for the contemporary surgical management of stress incontinence

Abstract

The purpose of this article is to evaluate the evidence base for surgical management of stress urinary incontinence in women between July 2006 and December 2007. The Urinary Incontinence Treatment Network and Pelvic Floor Diseases Network have contributed level 1 evidence in the management of stress urinary incontinence with multicentric randomized controlled trials. Pubovaginal sling has a higher success rate than the Burch at the expense of a higher morbidity. A prophylactic Burch procedure at the time of an abdominal sacrocolpopexy can reduce secondary stress urinary incontinence and urge urinary incontinence. Suburethral tapes have a higher cure rate for patients with predominant stress urinary incontinence and can safely be placed at the time of concomitant pelvic surgery. The tension-free vaginal tape has a higher rate of lower urinary tract injury and voiding dysfunction when compared with transobturator tape. The Burch and pubovaginal sling have a high success rate for treating stress urinary incontinence. Prospective randomized trials are needed to assess the long-term results of suburethral slings. There is still no consensus on outcome measures when reporting on surgical management for stress urinary incontinence.