Surgical management of female stress urinary incontinence

Stress urinary incontinence in women is a common problem in Germany, with approx. 5 million women suffering from incontinence symptoms. These numbers are increasing, due to demographic changes; the suspected numbers are even higher. Prior to treatment, an extended diagnostic approach - including urodynamics and cystoscopy when necessary - is essential for optimal treatment selection. Primary treatment should be conservative, with pelvic floor training as an essential part of a multi-modal treatment concept. If conservative treatment fails, surgery is necessary and an increasing number of women are being treated with sub-urethral slings. The use of classical and well-known reconstructive surgeries-such as colposuspensions-is decreasing. An artificial urinary sphincter is a seldom indication in women, but a feasible option if the patient is physically and manually fit enough. The following article will summarise current diagnostic approaches and treatment options.