What is the role of surgery in the treatment of stress urinary incontinence in women?

Updated: Jan 22, 2021
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Surgical care for stress incontinence involves procedures that increase urethral outlet resistance. In women, recommended procedures include the following [107] :

  • Midurethral sling (synthetic)
  • Autologous fascia pubovaginal sling
  • Bladder neck suspension (Burch colposuspension)

In a randomized study of 460 women with moderate to severe stress urinary incontinence, 90.8% of those who underwent midurethral sling surgery reported improvement at 1-year follow-up, compared with 64.4% of those who underwent physiotherapy training. [108, 109] The rate of objective cure was 76.5% in the surgery group and 58.8% in the physiotherapy group.

Midurethral slings may be transobturator or retropubic. [107] Transobturator vaginal tape (TVT-O) is widely used for stress incontinence in women. In an Italian study of 181 consecutive cases of TVT-O surgery, Serati et al found no significant difference between older women (70 years or older) and younger women in terms of cure rate, voiding dysfunction, vaginal erosion, persistent groin pain, or onset of de novo overactive bladder. [7]  The cure rate was 88.3% for the older group and 92.5% for the younger group.

In a study specifically focusing on the use of TVT-O in women with urodynamically proven, pure stress incontinence, Serati et al found TVT-O implantation to be a highly effective treatment option in this population, with a very high cure rate and a low complication rate. [110] The 5-year subjective cure rate was 90.3%, and the 5-year objective cure rate was 90.8%. The incidence of de novo overactive bladder was 24.3% at 5 years; no factor predictive of this condition was identified.

A review of long-term outcome in over 95,000 English women who had a first-ever midurethral mesh sling insertion for stress urinary incontinence estimated that the rate of mesh sling removal at 9 years is 3.3%. The removal risk after transobturator insertion was lower than the risk after retropubic insertion (2.7% versus 3.6%, respectively). [111]

For more information, see Vaginal Sling Procedures.

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