[Increase in number of operations for stress urinary incontinence]

Since the introduction of the minimally invasive tension-free vaginal tape (TVT) the number of operations performed for treatment of stress urinary incontinence has increased dramatically from over 1600 in 1999 to more than 4200 in 2003. Both gynaecologists and urologists now perform more TVTs and fewer Burch colposuspensions and Marshall-Marchetti-Krantz operations. This increase was apparent before data from proper studies on the effectiveness of the TVT were available. With the increasing popularity of a new and more easily performed variant of the TVT, the transobturator tape, the number of operations is likely to increase further. Gynaecologists and urologists must remain critical in the recommendation of these operations, since complications such as urinary retention and overactive-bladder syndrome with urgency or urge incontinence are well known and difficult to treat. Pelvic-floor physiotherapy, which is accepted by gynaecologists, urologists and general practitioners, should remain the first-line treatment for stress urinary incontinence.