Surgical management of stress urinary incontinence: consideration for an algorithmic approach

Stress urinary incontinence is defined as the symptomatic loss of urine related to increases in intra-abdominal pressure. A variety of nonsurgical therapies with varying degrees of effectiveness and patient acceptance are available. If nonsurgical therapies fail, then multiple surgical options exist, including retropubic urethropexy, bulking agents, pubovaginal slings, and sling variants. A surgical algorithm based on the amount of anterior vaginal wall prolapse (including urethrovesical mobility) and urethral sphincter function utilizing these procedures is reported herein.