Female Stress Urinary Incontinence Research Articles

Cystoscopic removal of transvaginal mesh: Long-term outcomes.

This study's aim is to evaluate the long-term quality of life and functional outcomes following cystoscopic excision of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) mesh extruded into the urinary tract in women. A retrospective chart review was performed of all cases of cystoscopic removal of extruded mesh at our high-volume tertiary care centre between April 2013 and August 2021. Postoperative patient-reported outcomes were collected via questionnaires: Urogenital Distress Inventory Short Form (UDI-6), EQ-5D-5L Visual analogue scale, ICIQ-Satisfaction (ICIQ-S) and additional questions regarding postoperative sexual function. During the study period, 27 women with a median age of 61 years (45-87) underwent cystoscopic mesh removal surgery using either Ho-YAG laser (56%) or bipolar loop resection (44%). The most common presentation of mesh extrusion was recurrent urinary tract infections (67%). Other presenting complaints were pain (41%), urinary urgency ± incontinence (41%) and voiding difficulties (18%). Long-term follow-up outcomes from 20 patients (median follow-up: 24 months) showed that mesh removal was rated successful by 80%, and 100% would choose to have the surgery again if in the same situation. Recurrent SUI was reported by 45% of respondents, and urinary urge incontinence was found in 50%. For patients who answered the sexual function questions, 50% reported improved sexual function postmesh removal (6/12). Cystoscopic removal of extruded female SUI and POP mesh is associated with high patient satisfaction and low morbidity in appropriately selected patients at 2-year median follow-up. A patient-centred shared decision-making process is essential in counselling patients regarding options and expected outcomes following mesh removal surgery.

78 - Urodynamics predictive value of postoperative urinary retention after female stress urinary incontinence surgery

78 - Urodynamics predictive value of postoperative urinary retention after female stress urinary incontinence surgery

Functional outcomes of mid-urethral tapes in female neurogenic stress and mixed urinary incontinence: A single centre experience

Study design:Retrospective Objectives:To evaluate the mid-term urodynamic and clinical efficacy of mid-urethral synthetic sling (MUS) in females with neurogenic stress urinary incontinence (N-SUI) or neurogenic mixed urinary incontinence (N-MUI). Materials and methods:Between January and April 2021, we conducted a retrospective review of all adult neurological women with clinically and urodynamically proven N-SUI or N-MUI who were treated with retropubic (TVT) or transobturator (TOT) tension free vaginal tape. The outcomes were recorded in a database over a 14-year period.The primary objective outcome measure was the absence of any N-SUI episodes at 3 days Bladder Diary (BD). A Patient Global Impression of Improvement (PGI-I) score ≤ 2 was a secondary endpoint for subjective success. Objective failure was defined as the detection of stress urinary incontinence during follow-up urodynamics. Results:Twenty-three women out of 65 were included. Mean follow-up was 72.2 ± 45.6 months. TVT was placed in 17/23 patients (74%) who were previously managed by intermittent catheters (IC) and TOT in those 6/23 women (26%) who spontaneously voided at baseline.Dryness at 3 days BD was observed in 12/23 patients (52%). Twenty patients (86%) reported subjective benefits (mean PGI-I 1.4 ± 0.62), of whom eleven (55%) were extremely satisfied (PGI-I = 1).Objective failure was documented in 2/23 women (8%) after surgery. Two patients shifted from IC to indwelling catheter during follow-up (respectively 6 and 8 years after surgery). De novo neurogenic detrusor overactivity was observed in two women at 3 months follow-up. No statistical differences were observed in cystometric parameters comparing baseline to follow-up. Conclusion:To the best of our knowledge, this is the first study confirming the clinical efficacy and urodynamic safety over a 5-year follow-up, for N-MUI as well. According to our results both TOT and TVT can be used to treat women with N-SUI with or without concomitant NDO. The choice between the two procedures depended on baseline bladder management.

Modified lumbo-pelvic exercise to alleviate mild stress urinary incontinence in middle-aged females

Urinary incontinence is one of the common clinical problems of females passing middle age. Traditional pelvic floor muscle training to alleviate urinary incontinence is too dull and unpleasant. Therefore, we were motivated to purpose a modified lumbo-pelvic exercise training incorporating simplified dancing components with pelvic floor muscle training. The objective of this study was to evaluate the 16-week modified lumbo-pelvic exercise program that incorporated dance and abdominal drawing-in maneuvers. Middle-aged females were randomly assigned into the experimental (n = 13) and control (n = 11) groups. Compared to the control group, the exercise group significantly reduced body fat, visceral fat index, waistline, waist-hip ratio, perceived incontinence score, frequency of urine leakage, and pad testing index (p < 0.05). In addition, there were significant improvements in pelvic floor function, vital capacity, and muscle activity of the right rectus abdominis (p < 0.05). This indicated that the modified lumbo-pelvic exercise program can promote benefits of physical training and alleviate urinary incontinence in middle-aged females.

Identifying Womens' Needs in Making a Treatment Decision for Stress Urinary Incontinence: A Qualitative Study.

Choosing a treatment option for female stress urinary incontinence (SUI) is a preference-sensitive decision. Nowadays, shared decision making (SDM) is the preferred way of decision making. SDM considers the needs patients have regarding the decision-making process. The aim of this study was to identify decisional needs of women who are making a treatment decision for SUI. Semistructured interviews were planned with women who had been seeking treatment for SUI. Patients were recruited in two teaching hospitals in the Netherlands. Interviewers used a topic list based on the Ottawa decision support framework. The interviews were transcribed and coded. Themes and subthemes of factors relating to the treatment decision-making process were identified and described. We interviewed a total of 16 women. Four major themes of SUI patients' needs were identified: information on disorder and treatment, SDM, personalized health care, and consideration for social context. Within these themes, specific needs varied between individuals. In addition to the provision of objective information, other important identified needs were subjective, such as acknowledgment of symptoms and feeling understood by a physician. It was important for patients that they had a sufficient amount of time to make their decision. To ensure a good quality treatment decision in female SUI, several topics need to be addressed in an SDM process. The themes of decisional needs identified in this study can help improve the decision-making process.

Three-year patient-reported outcomes of single-incision versus transobturator slings for female stress urinary incontinence are equivalent.

Patient-reported outcome measures (PROMs) are important for understanding the success of surgery for stress urinary incontinence, as patient perception of success does not always correlate with physician perception of success. We report PROMS after single-incision slings (SIS) and transobturator mid-urethral slings (TMUS). This was a planned outcome analysis of secondary endpoints in a study in which the primary aim was to compare efficiency and safety using a non-inferiority design (results reported previously). In this analysis of quality of life (QOL), validated PROMs were collected at baseline, 6, 12, 18, 24, and 36 months to quantify incontinence severity (Incontinence Severity Index), symptom bother (Urogenital Distress Inventory), disease-specific QOL impact (Urinary Impact Questionnaire), and generic QOL impact (PGI-I; not applicable at baseline). PROMs were analyzed within treatment groups as well as between groups. Propensity score methods were used to adjust for baseline differences between groups. A total of 281 subjects underwent the study procedure (141 SIS, 140 TMUS). Baseline characteristics were balanced after propensity score stratification. Participants had significant improvement in incontinence severity, disease-specific symptom bother, and QOL impact. Improvements persisted through the study and PROMs were similar between treatment groups in all assessment at 36 months CONCLUSIONS: Following SIS and TMUS, patients with stress urinary incontinence had significant improvement in PROMs including Urogenital Distress Inventory, Incontinence Severity Index, and Urinary Impact Questionnaire at 36 months, indicating disease-specific QOL improvement. Patients have a more positive impression of change in stress urinary incontinence symptoms at each follow-up visit, indicating generic QOL improvement.

Updates to Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline (2023)

The purpose of this guideline is to provide a clinical structure with which to approach the diagnosis, counseling, and treatment of female patients with stress urinary incontinence (SUI). The primary source of evidence for the 2017 version of the SUI guideline was the systematic literature review conducted by the ECRI Institute. The initial search spanned literature from January 2005 to December 2015, with an additional updated abstract search through September 2016. The current amendment represents the first update to the 2017 iteration and includes updated literature published through February 2022. This guideline has been amended to reflect changes in and additions to the literature since 2017. The Panel maintained that the differentiation between index and non-index patients remained important. The index patient is a healthy female with minimal or no prolapse who desires surgical therapy for treatment of pure SUI or stress-predominant mixed urinary incontinence. Non-index patients have factors that may affect their treatment options and outcomes, such as high grade prolapse (grade 3 or 4), urgency-predominant mixed incontinence, neurogenic lower urinary tract dysfunction, incomplete bladder emptying, dysfunctional voiding, SUI following anti-incontinence treatment, mesh complications, high body mass index, or advanced age. While gains have been made in the field to support new methods for the diagnosis, treatment, and follow-up of patients with SUI, the field continues to expand. As such, future reviews of this guideline will take place to stay in keeping with the highest levels of patient care.

Single Incision Midurethral Sling Site of Care: Office-based Ambulatory Surgical Unit versus Hosptial-based Ambulatory Surgical Unit Setting

To compare the economic difference in terms of overall costs between two Ambulatory Surgical Unit (ASU) settings in which a midurethral single incision sling (MSIS) can be performed. A retrospective cohort study was carried out, examining the implanting of an MSIS performed at two different ASU settings by a single surgeon. Total cost was determined by assessing differences in charges and subsequent reimbursement associated with the procedure at each ASU setting. Time was measured using an EMR system for tracking both patient entry/exit from the facility as well as intraoperative time. Adverse events commonly associated with the procedure and patient-reported unanticipated adverse events were collected. A validated Surgical Satisfaction Questionnaire was administered postoperatively. University Health Network Teaching Hospital. A total of 125 women with stress urinary incontinence. MSIS. Between January 2016 until August 2020, 125 women underwent an MSIS procedure. The total office-based ASU (O-ASU) charges averaged $4564.00 (reimbursement of $2642.07). The total hospital-based ASU (H-ASU) charges averaged $40 136 (reimbursement of $9000), as well as an anesthesia average charge of $800 (reimbursement of $500). The average O-ASU total patient encounter time was 53.76 minutes versus 344.702 minutes for the H-ASU. There was no difference between commonly associated or unanticipated adverse events nor global patient satisfaction. Based on overall cost, total encounter time, and global patient satisfaction, a certified O-ASU is an optimal site of care for MSIS for surgical management of female stress urinary incontinence.

Adjustable slings versus other surgical methods in female stress urinary incontinence: a systematic review and meta-analysis.

The objective of this study was to evaluate the efficacy and safety of different adjustable slings compared to other surgical methods for the treatment of stress urinary incontinence (SUI) among women. The inclusion criteria were as follows: randomized controlled trials (RCTs) and non-RCTs assessing adult women with SUI. The exclusion criteria were as follows: other types of urinary incontinence, studies that combined conservative interventions and pharmacological treatment, pregnant and lactating patients. Databases were searched up to November 2022 to identify articles evaluating the effectiveness and safety of different adjustable slings compared to other surgical methods for the treatment of SUI among women. The systematic review was conducted in accordance with the PRISMA 2020 checklist and registered in PROSPERO. Risk-of-bias assessment tools recommended by the Cochrane Society were used to evaluate the risk of bias in the included studies. Eighteen clinical trials were included in this systematic review, and 11 studies were included in the meta-analysis. Fourteen studies were RCTs, and four were retrospective studies. Only RCTs were included in the meta-analyses. There was no statistically significant difference in the objective cure rate, subjective cure rate, or long-term postoperative complication rate between Ajust single-incision mini-slings (SIMS) and standard mid-urethral slings (SMUS) or MiniArc SIMS. However, the operation time in the adjustable SIMS group was significantly shorter (RR = -4.20, 95% CI: [-7.51, -0.89], p = 0.01). This systematic review and meta-analysis revealed that adjustable SIMS is equally effective when compared with SMUS for the treatment of SUI among women. Moreover, the operation time for the adjustable SIMS was shorter. However, additional well-designed studies with standard outcome measures and complete follow-up periods will help to increase confidence in the choice of different options for treating SUI among women.

Design and Experimental Study of Magnetic Control Device for the Treatment of Female Stress Urinary Incontinence

Zhang, Miaomiao; Yan, Xiaopeng MD, PhD; Shi, Aihua PhD; Ma, Jia; Lyu, Yi MBBS, MS, FACS Author Information

The “Aberdeen Home Continence Stress Test”: a novel objective assessment tool for female stress urinary incontinence

Introduction and hypothesisClinical trials for stress urinary incontinence (SUI) require a robust, reliable, and responsive tool for objective assessment of SUI post-intervention. The Aberdeen Home Continence Stress Test (HCST) is a novel patient-reported objective assessment tool, aimed to be patient-friendly and reduce attrition rates by avoiding hospital appointments and prolonged pad-wearing. We aim to describe the HCST for the first time and evaluate its reliability, diagnostic accuracy, and response to change.MethodsA secondary analysis of the Single-Incision Mini-Slings (SIMS) study (a prospective multicentre randomised control trial (RCT) comparing two surgical treatments of SUI was performed. In SIMS (n = 600 women), the objective outcome was assessed by the 24-h pad test, while the patient-reported success rates were assessed using the Patient Global Impression of Improvement (PGI-I) at 15 months, 2 years and 3 years post-randomisation. Participants were instructed to perform the HCST before and after the 24-h pad test. The HCST was analysed in relation to reliability, validity, and the relationship between the 24-h pad test and HCST results and finally with regard to its responsiveness to change in PGI-I. (Trial registration-number ISRCTN93264234, registration date 14/01/2014).ResultsCompared to the 24-h pad test, the sensitivity of the HCST ranged from 0.81–0.95, specificity was 0.76–0.79, negative predictive value was 0.96–0.99 and positive predictive value was 0.32–0.43. Reliability was indicated by high-performing Cronbach’s alpha value (> 0.7). An improvement of ≥ 2 leakage groups on the HCST (for example from Large at baseline to Small leakage at follow-up) was strongly associated with patient-reported success on PGI-I (OR 4.38, 95% CI 2.31, 8.31).ConclusionsThe HCST is a valid and reliable patient-reported objective assessment tool that can be used for assessing SUI in surgical trials with good specificity, sensitivity, and consistency.

Transurethral injection of autologous muscle precursor cells for treatment of female stress urinary incontinence: a prospective phase I clinical trial

Introduction and hypothesisThe purpose was to investigate the safety and feasibility of transurethral injections of autologous muscle precursor cells (MPCs) into the external urinary sphincter (EUS) to treat stress urinary incontinence (SUI) in female patients.MethodsProspective and randomised phase I clinical trial. Standardised 1-h pad test, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), urodynamic study, and MRI of the pelvis were performed at baseline and 6 months after treatment. MPCs gained through open muscle biopsy were transported to a GMP facility for processing and cell expansion. The final product was injected into the EUS via a transurethral ultrasound-guided route. Primary outcomes were defined as any adverse events (AEs) during follow-up. Secondary outcomes were functional, questionnaire, and radiological results.ResultsTen female patients with SUI grades I–II were included in the study and 9 received treatment. Out of 8 AEs, 3 (37.5%) were potentially related to treatment and treated conservatively: 1 urinary tract infection healed with antibiotics treatment, 1 dysuria and 1 discomfort at biopsy site. Functional urethral length under stress was 25 mm at baseline compared with 30 mm at 6 months’ follow-up (p=0.009). ICIQ-UI-SF scores improved from 7 points at baseline to 4 points at follow-up (p=0.035). MRI of the pelvis revealed no evidence of tumour or necrosis, whereas the diameter of the EUS muscle increased from 1.8 mm at baseline to 1.9 mm at follow-up (p=0.009).ConclusionTransurethral injections of autologous MPCs into the EUS for treatment of SUI in female patients can be regarded as safe and feasible. Only a minimal number of expected and easily treatable AEs were documented.

Pelvic Floor Muscle Training for Urinary Incontinence After Radical Prostatectomy: A Narrative Review.

Rehabilitative treatment of urinary incontinence after prostatectomy has showed, on the basis of recent published evidence, encouraging results. At first, clinician applied evaluation and treatment approach suggested based on the studies and rationale of female stress urinary incontinence, but although long term literature suggested no evidence of benefits. Recent studies that have shown the real control mechanisms in male continence through the use of trans-perineal ultrasound, demonstrated that it is not appropriate to transfer the rehabilitation techniques applied in female stress incontinence to male incontinence after prostatectomy. Even that pathophysiology of urinary incontinence after prostatectomy is not fully understood, it's in part attributable to a urethral or bladder source. In particular, however, urethral sphincter dysfunction is predominant, secondary to surgical damage and to the partly organic and partly functional dysfunction of the external urethral sphincter; complementary action of all the muscles capable of contributing to the maintenance of urethral resistance is therefore important. As for rehabilitative approach to post-prostatectomy incontinence, the primary objective is to quantify the residual capacity of the muscular function that must replace the sphincter function, often compromised by surgery. Than a multimodal approach, comprising exercise and instrumental therapies, is needed. The present paper's aim was to overview current urinary dysfunction knowledge for male with radical prostatectomy, and to describe practical issue of evaluation and conservative treatment.

A Molecular Landscape of Stress Urinary Incontinence in Women Suggests an Important Role of Beta-Catenin Signaling in Disease Etiology

Purpose: Stress urinary incontinence (SUI) represents a major health burden in women, but a thorough understanding of the underlying molecular mechanisms is lacking. Our aim was to further elucidate these mechanisms to ultimately find new treatments. Materials and Methods: This study integrated the most significant genes from 4 genome-wide association studies (GWASs) of SUI in women with other genetic, expression, and/or functional evidence from the literature into a molecular landscape. A network enrichment analysis of the top SUI GWAS genes was conducted, followed by an extensive literature search to identify interactions between the proteins encoded by the GWAS genes and proteins/molecules implicated in SUI through other evidence. Results: In total, 188 GWAS genes were used for network enrichment analysis that yielded 12 networks, of which 8 were overlapping, with beta-catenin as the central protein. Based on this finding and our literature search, we built a molecular landscape of female SUI that centers on beta-catenin signaling. Other important functional landscape themes are epithelial-mesenchymal transition, NANOG signaling, and female sex hormone signaling. Conclusions: The molecular landscape of female SUI that we built based on genetic data provides novel molecular insights that may be instrumental for better understanding the etiology of SUI and developing novel SUI treatments.

Outcome of transobturator sling for treatment of female stress urinary incontinence applied as a single procedure or concomitantly with pelvic organ prolapse surgery.

The aim of the study was to check the safety and efficacy of transobturator tape (TOT) combined with various prolapse procedures. The results were compared with outcomes of sling performed as an alone surgery. Risk factors for TOT failure were also identified. The study comprised 219 patients with sling alone (Group SUI) and 221 after TOT combined with concomitant prolapse surgery (Group POP/SUI). Medical records were carefully reviewed to obtain demographic and clinical data, details of surgery, including intra-and postoperative complications. Subjective cure rate was slightly, but statistically significantly, higher in POP/SUI group (89.6% vs 82.6%; ch2 = 4.44; p = 0.035). There was no significant difference in sling efficacy dependant of type of POP surgery. Post-operative urine retention was more frequent in POP/SUI group compared to SUI group (18.6% vs 3.2%; ch2 = 34.36; p < 0.001). Logistic regression showed that age, BMI and prolonged pos-operative urine retention are independent factors affecting TOT outcome. Age ≥65years and BMI ≥30kg,m2 more than doubled the risk of failure: OR 2.348, CI 95% (1.330-4.147); p = 0.003 and 2.030, (95% CI 1.148-3.587); p = 0.015; respectively. Interestingly, post-operative urine retention appeared to be a positive prognostic factor OR 0.145, (95% CI 0.019-1.097); p < 0.05. Subjective efficacy of TOT used concomitantly with POP procedures is slightly higher than TOT alone. Better sling outcomes can be expected both for POP procedures involving both the anterior and posterior compartments. Age and obesity are independent factors of TOT failure, whereas prolonged post-operative urine retention is a positive predictive factor of TOT success.

Perineal ultrasound to assess the urethral spatial movement in stress urinary incontinence in women

BackgroundPerineal ultrasound as a non-invasive method for the diagnosis of female stress urinary incontinence has attracted more and more attention. However, the criteria for stress urinary incontinence in women using perineal ultrasound have not been fully established. Our study aimed to evaluate characteristics of the urethral spatial movement with perineal ultrasonography.MethodsA total of 136 female patients with stress urinary incontinence and 44 controls were enrolled. Stress urinary incontinence was diagnosed using the International Consultation on Incontinence Questionnaire Short Form, medical history and physical examination, and severity was assessed using a 1 h pad test. We described the mobility of four equidistant points (A–D) located along the urethra length. The retrovesical and urethral rotation angles were measured using perineal ultrasonography at rest and during the maximal Valsalva maneuver.ResultsPatients with stress urinary incontinence showed a more significant vertical movement at Points A, B and C than controls. The mean variations in the retrovesical angle were significantly larger in patients with stress urinary incontinence at rest and during the Valsalva maneuver than in controls (21.0 ± 16.5° vs. 14.7 ± 20.1°, respectively). The cut-off value for the retrovesical angle variation was 10.7° with 72% sensitivity and 54% specificity. There was a receiver-operating characteristic curve area of 0.73 and 0.72 for Points A and B, respectively. A cut-off of 10.8 mm, and 9.4 mm provided 71% sensitivity and 68% specificity and 67% sensitivity and 75% specificity, respectively.ConclusionsThe spatial movement of the bladder neck and proximal urethra, and variations in the retrovesical angle may be correlated with clinical symptoms and facilitate to the assessment of SUI.

Pelvic ultrasound finding of late-onset bladder erosion after transobturator tape for female stress urinary incontinence: A case report.

Mid-urethral sling is a gold-standard procedure for stress urinary incontinence because of its high efficacy and low complication incidence. Moreover, mesh erosion into the bladder is a rare complication. The 63-year-old patient visited our gynecology clinic with complaints of gross hematuria and was diagnosed with bladder erosion by ultrasound 6 months after transobturator tape procedure. The 2D ultrasound found the sling in the bladder wall perforation, which can lead to the formation of bladder stones. Meanwhile, 3D ultrasound showed the left side of the sling crossed the bladder mucosa at 5 o'clock. The sling and bladder stones were removed by holmium laser. The patient underwent a follow-up pelvic ultrasound at 6 months, which showed no erosion mesh under the bladder mucosa. Pelvic ultrasound could accurately evaluate the location and shape of the tape, which is important for a reasonable surgical plan.

Impact of COVID-19 on surgical procedures for stress urinary incontinence in the Brazilian public health system.

The objective was to characterize the impact of the COVID-19 pandemic on the surgical treatment of female stress urinary incontinence (FSUI) in Brazil. This study was conducted with population-based data from the Brazilian public health system database. We obtained data on the number of surgical procedures for FSUI in 2019 (before the coronavirus disease [COVID-19] pandemic), 2020, and 2021 (during the pandemic) in each of the 27 Brazilian states. We included official Brazilian Institute of Geography and Statistics (IBGE) data on the population, Human Development Index (HDI), and annual per capita income of each state. A total of 6,718 surgical procedures for FSUI were performed in the Brazilian public health system in 2019. The number of procedures was reduced by 56.2% in 2020, and an additional reduction of 7.2% was seen in 2021. The distribution of procedures by state showed important differences, ranging from 4.4 procedures/1,000,000 inhabitants in Paraíba and Sergipe to 67.6 procedures/1,000,000 inhabitants in Paraná (p<0.01) in 2019. The number of surgical procedures was higher in states with a higher HDI (p=0.0001) and per capita income (p=0.042). The decrease in the number of surgical procedures affected the whole country and its rate did not correlate with HDI (p=0.289) or per capita income (p=0.598). The impact of the COVID-19 pandemic on the surgical treatment of FSUI in Brazil was significant in 2020 and persisted in 2021. Access to surgical treatment of FSUI varied according to geographic region, HDI, and per capita income, even before COVID-19.

Treatment of Female Stress Urinary Incontinence with Urethral Bulking

Treatment of Female Stress Urinary Incontinence with Urethral Bulking

Correlation between trans-perineal ultra-sonography, urodynamic study and physical examination findings in female patients with stress urinary incontinence: Single center experience.

To evaluate the efficacy of Trans-perineal ultrasonography (TPUS) in assessment of stress urinary incontinence (SUI) and its correlation with urodynamic study (UDS) and physical examination in women with SUI. The study enrolled a total of 91 females including 66 women with SUI and 25 women with no history of urinary incontinence as control group. The α and β angles (anterior urethral and posterior urethro-vesical angle respectively) were recorded both at rest and at straining, using TPUS. The differences between these angles at rest and during the straining were considered as the rotational angles (Rα and Rβ). Urethral length and caliber, bladder neck funneling, and pubo-urethral distance were measured as well. The mean (SD) α angle at rest of the SUI group was 49.0 (±14.3)°, which was higher than the same parameter in the control group: 47.6 (±9.7)°. Similarly, the α angle at straining was significantly higher in the SUI group versus the control group, 61.0 (±15.4)° versus 55.8 (±15.8)°. The mean (SD) β angle in the SUI group at rest was 124.6 (±28.5)°, which was significantly higher than that of the control group at 114.0 (±22.5)°. The mean (SD) β angle at straining was also higher in the SUI group versus the control group: 151.8 (±90.6) versus 136.0 (±27)°. Moreover, higher Rα and Rβ angels were documented in the SUI group. Our data suggest that TPUS can be considered as a non-invasive, easily conducted, and accurate modality in early diagnosis of female SUI. It may reduce the need for performing relatively invasive UDS. However, the role of TPUS in assessment of SUI severity remains to be studied probably with a larger sample size.