Management of stress urinary incontinence

Female stress urinary incontinence (SUI) is a common condition with significant impact on a woman's quality of life. The prevalence of SUI is about 50%. Previously, the majority of incontinence procedures were performed via an abdominal approach (Burch colposuspension). The tension-free procedures, with a synthetic tape material, have replaced almost completely the previous surgeries and is nowadays considered the gold standard option for surgical treatment of female SUI. A wide spectrum of tape based surgical procedures and devices are currently available. Today, Burch colposuspension has a role in patients undergoing abdominal pelvic organ prolapse (POP) repair as a concomitant procedure in those patients with urethral hypermobility or those with contraindication to mid-urethral slings (MUS) placement. The objective success rate reported of this procedure ranges between 49% and 88%. Mid urethral synthetic slings represent the most common procedures for SUI in North America and Europe. Cure rate of retropubic MUS approaches 86% with a satisfaction rate of about 75%. For transobturator tape MUS the objective success rate at 12 months is 87% and the satisfaction rate is 85%. Single incision mini-slings (SIMS) were introduced in 2003 and they have a different anchoring mechanism, located at the two extremities, that allows the stabilization of the tape in the obturator internal muscle or deeper in the obturator channel trough a single vaginal incision. Reported objective cure rate is 78% and satisfaction rate is 82%. According to the most recent EAU guidelines about incontinence and the UK National Institute for Healthcare and Clinical Excellence (NICE), the surgeon must be able to offer alternative surgical treatments and have the knowledge of efficacy and safety of these approaches at counseling of the patient. The objective cure rate is rather similar among the different types and routs of mid-urethral slings and the difference vs. Burch colposuspension seems to disappear at 5 years followup, when effectiveness is comparable. There is no significant difference in erosion rates between transobturator and retropubic approaches among mid-urethral tapes, but they are lower when compared to SIMS. The injury rate of nearby organs is quite low for all types of approaches, except for retropubic slings. (C) 2016 Elsevier Inc. All rights reserved.