[Surgical concepts in female urinary stress incontinence]

Severe anatomical and functional defects and failure or rejection of conservative treatment are clear indications for surgical repair of sphincter incompetence. Adequate pretherapeutical diagnostic work-up should rule out other reasons for incontinence and additional pathology and allow adequate selection of the surgical technique. Prospective randomized studies as well as meta-analyses enable us to recognize suitable procedures; for primary surgery colposuspension and tension-free vaginal tapes (TVT), and in selected cases traditional slings can be recommended, whereas vaginal repairs, needle suspensions and the different injectables should not be encouraged for primary cases.