An Overview of Surgical Treatment for Female Stress Urinary Incontinence

Abstract

We aimed to present an overview of recent data on the proven surgical techniques for female stress urinary incontinence (SUI) including their efficacy, safety, and adverse events. Surgical treatment of female SUI is the mainstay of urogynecological surgery, with two accepted gold standard techniques: Burch colposuspension and synthetic midurethral slings (MUS). Thorough understanding of the historical evolution of the surgical techniques before and after the introduction of integral theory is important. This theory enhances our comprehension for the continence mechanism of MUS, which are currently the level 1, grade A, recommended anti-incontinence procedures in all recent guidelines. However, in cases with specific contraindications, mesh surgery should be avoided. Burch colposuspension and autologous rectus fascia pubovaginal sling (RF PVS) procedures are the recommended surgical techniques with level 1 evidence in such cases and should be performed after a complete evaluation. Urethral bulking agents and artificial sphincters are the other options for severe and complicated cases. Because each surgical intervention for female SUI has inherent advantages and risks of complications, selection of the optimal surgical technique should be based on the risk-benefit ratio for every patient. Comprehension of recent data derived from systematic meta-analyses and latest guidelines and knowledge of the safety, long-term efficacy, and possible adverse events of all currently accepted surgical techniques for female SUI provide an insight to properly counsel women and to select the optimal individualized anti-incontinence surgery.