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Purpose of Review <p>This chapter provides a comprehensive overview of current surgical interventions for stress urinary incontinence (SUI) in females. It aims to elucidate the history, mechanisms, efficacy, complications, and evolving trends associated with these procedures in an effort to guide clinicians in surgical decision making.</p> Recent Findings <p>Midurethral slings (MUS) including retropubic, transobturator, and single-incision mini-slings (SIMS) remain the cornerstone of SUI surgical management. Several studies have investigated the differences associated with MUS including the ‘TOMUS’ study comparing short and long term efficacy between the retropubic and transobturator versions of the sling. SIMS offers a less invasive approach but long term outcomes are still under investigation. More historic approaches such as the Burch colposuspension, serve as a viable option for those in which mesh is contraindicated. Autologous fascial slings present a mesh-free solution may benefit patients with prior mesh associated complications albeit with increased operative morbidity. Urethral bulking has been in use for the better part of the last century, and current options are undergoing further investigation for long term efficacy. Emerging therapies including stem cell interventions and vaginal laser therapies are currently being explored for their use in SUI management.</p> Summary <p>Individualized treatment is at the foundation of SUI surgical management with several options management. While MUS currently dominates in the practice of SUI surgical correction due to higher efficacy and minimally invasive nature, alternative surgeries such as the Burch and autologous fascial slings remain medically sound options for certain patient populations. Furthermore, urethral bulking is gaining popularity due to its minimally invasive nature and only slightly lower efficacy than MUS in short term studies and can serve as an alternative for patients who are not candidates for the MUS. These therapies often require multiple injections over time to maintain symptom control. Ongoing investigations into novel therapies will continue to expand the landscape of surgical management for SUI.</p>

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Surgical Management of Stress Urinary Incontinence: Evolution, Evidence, and Emerging Frontiers

  • 期刊论文

  • 发表日期：

    2026年1月3日

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  • Amine Sahmoud,
  • Vivian Roan,
  • Lahari Nandikanti,
  • Sangeeta Mahajan

摘要

Purpose of Review

This chapter provides a comprehensive overview of current surgical interventions for stress urinary incontinence (SUI) in females. It aims to elucidate the history, mechanisms, efficacy, complications, and evolving trends associated with these procedures in an effort to guide clinicians in surgical decision making.

Recent Findings

Midurethral slings (MUS) including retropubic, transobturator, and single-incision mini-slings (SIMS) remain the cornerstone of SUI surgical management. Several studies have investigated the differences associated with MUS including the ‘TOMUS’ study comparing short and long term efficacy between the retropubic and transobturator versions of the sling. SIMS offers a less invasive approach but long term outcomes are still under investigation. More historic approaches such as the Burch colposuspension, serve as a viable option for those in which mesh is contraindicated. Autologous fascial slings present a mesh-free solution may benefit patients with prior mesh associated complications albeit with increased operative morbidity. Urethral bulking has been in use for the better part of the last century, and current options are undergoing further investigation for long term efficacy. Emerging therapies including stem cell interventions and vaginal laser therapies are currently being explored for their use in SUI management.

Summary

Individualized treatment is at the foundation of SUI surgical management with several options management. While MUS currently dominates in the practice of SUI surgical correction due to higher efficacy and minimally invasive nature, alternative surgeries such as the Burch and autologous fascial slings remain medically sound options for certain patient populations. Furthermore, urethral bulking is gaining popularity due to its minimally invasive nature and only slightly lower efficacy than MUS in short term studies and can serve as an alternative for patients who are not candidates for the MUS. These therapies often require multiple injections over time to maintain symptom control. Ongoing investigations into novel therapies will continue to expand the landscape of surgical management for SUI.