CLINICAL ACTIONS:

• Surgery may be indicated for women with stress (not urge) urinary incontinence who have failed conservative management (see ‘Related ObG Topics’ below) or who decline conservative management
• Synthetic mid-urethral mesh slings are the most common primary surgical treatment for women with stress urinary incontinence (SUI) and are recognized as standard of care by the AUGS and others
• Slings may be retropubic or transobturator
• Subjective cure rates range from 62% to 97% and are similar for both approaches

SYNOPSIS:

Surgery for stress urinary incontinence (SUI) is generally well tolerated with excellent cure rates for either retropubic or transobturator mesh slings. Voiding dysfunction, bladder perforation, vascular and/or visceral injury as well as operative blood loss are more common with retropubic slings. Groin pain, sometimes debilitating, is more common with transobturator slings. Autologous fascial bladder slings are appropriate in women with severe SUI and a nonmobile, fixed urethra (generally secondary to scarring from previous surgery), urethral diverticula or fistula, or complications from previously placed vaginal mesh.

KEY POINTS:

• Women with both pelvic organ prolapse and SUI should have concomitant surgical treatment of both
• Women with pelvic organ prolapse and no SUI may develop SUI after surgical correction of prolapse, and should be evaluated preoperatively by performing a cough stress test, with the prolapse reduced
• Women with pelvic organ prolapse, and without SUI who are undergoing either abdominal or vaginal prolapse repair should be counseled that postoperative SUI may occur unless an additional procedure is performed to prevent it
  • The risk of adverse effects is increased with the additional procedure

Learn More – Primary Sources:

ACOG Practice Bulletin No 155: Urinary Incontinence in Women

Surgical treatments for women with stress urinary incontinence: the ESTER systematic review and economic evaluation

AUGS Position Statement: Mesh Midurethral Slings for Stress Urinary Incontinence

Related ObG Topics:

Urinary Incontinence – How to Make the Diagnosis in Your Office and When to Refer

Treating Urinary Incontinence Without Surgery: Options and Pearls

Prolapse and Stress Incontinence: Burch Procedure vs Midurethral Sling

Midurethral Tape and Repeat Surgery for Stress Incontinence: Is the 2nd Time the Charm?

Mesh and Pelvic Organ Prolapse: ACOG Practice Advisory & ACOG/AUGS Recommendations