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  • Review Article
  • Published:

Surgical management of female SUI: is there a gold standard?

Nature Reviews Urology volume 10, pages 78–89 (2013)Cite this article

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A Correction to this article was published on 26 March 2013

This article has been updated

Abstract

Many surgical options exist for women with stress urinary incontinence (SUI). The traditional gold standards of Burch retropubic colposuspension and pubovaginal slings are still appropriate treatment options for some patients, but randomized controlled trials have demonstrated that synthetic midurethral slings are just as effective as these traditional procedures but with less associated morbidity. Thus, midurethral slings—inserted via a retropubic or transobturator approach—have become the new gold standard first-line surgical treatment for women with uncomplicated SUI. Retropubic midurethral slings are associated with slightly higher success rates than transobturator slings, but at the cost of more postoperative complications. Pubovaginal slings remain an effective option for women with SUI who have failed other procedures, have had mesh complications, or who require concomitant urethral surgery. Single-incision slings have a number of benefits, including decreased operative times and early return to regular activities, but they are yet to be shown to be as effective as midurethral slings. Both retropubic and transobturator midurethral slings are effective for patients with mixed urinary incontinence, but the overall cure rate is lower than for patients with pure SUI. Based on the literature, a new gold standard first-line surgical treatment for women with SUI is the synthetic midurethral sling inserted through a retropubic or transobturator approach.

Key Points

  • Many different surgical options have evolved for stress urinary incontinence (SUI), owing to its high prevalence; Burch colposuspension and autologous fascial pubovaginal slings are the traditional gold standards

  • Randomized controlled trials have demonstrated that synthetic midurethral slings are as effective as traditional surgeries (such as Burch colposuspension and pubovaginal slings) but with less associated morbidity

  • Midurethral slings have become the gold standard for treating uncomplicated female SUI

  • Retropubic midurethral slings are associated with slightly higher success rates than transobturator slings, but at the cost of more postoperative complications

  • Pubovaginal slings remain an effective option for women with SUI who have failed other procedures, have had mesh complications, or who require concomitant urethral surgery

  • Single-incision slings are not as effective as traditional midurethral slings

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Change history

  • 26 March 2013

    In the version of this article initially published online [text explaining the error]. The error has been corrected for the print, HTML and PDF versions of the article.

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  1. Division of Urology, University of Toronto, Sunnybrook Health Sciences Centre, Room MG 408, 2075 Bayview Avenue, Toronto, M4N 3M5, ON, Canada

    Ashley Cox, Sender Herschorn & Livia Lee

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A. Cox, S. Herschorn and L. Lee contributed to the researching of data for the article, discussion of content and writing the manuscript. A. Cox and S. Herschorn reviewed/edited the manuscript before submission.

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Correspondence to Sender Herschorn.

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S. Herschorn declares that he has been a Consultant for American Medical Systems and Promedon, and has received grant/research support (inc. clinical trials) from Contura (Johnson & Johnson). The other authors declare no competing interests.

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Cox, A., Herschorn, S. & Lee, L. Surgical management of female SUI: is there a gold standard?. Nat Rev Urol 10, 78–89 (2013). https://doi.org/10.1038/nrurol.2012.243

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  • DOI: https://doi.org/10.1038/nrurol.2012.243

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