Stress incontinence surgery: which operation when?

Many operations have been developed to treat stress urinary incontinence and yet, at present, there is no consensus about whether there is a single best surgery for all patients with this condition. Can a consensus be reached to determine the best surgical procedure? Can one surgery be successful for patients with varied characteristics, or should a specific procedure be applied to each individual patient?

There are many factors to consider when choosing an operation for stress urinary incontinence in an individual patient. Body habitus, prior pelvic surgery, including prior antiincontinence surgery, urethral function or obstruction or both, and the presence or absence of vaginal wall prolapse can all significantly impact on the potential surgical intervention. These characteristics may affect the choice of procedure with respect to optimizing a favorable outcome or minimizing the risk of a poor outcome or associated complications.

At present, there is no evidence to support the notion that there exists a single best operative intervention for all patients with stress urinary incontinence. There is a small but slowly developing literature base by which to guide the choice of surgical procedure for contemporary treatment of stress urinary incontinence in individual patients.