Management of recurrent genuine stress incontinence

Recurrent stress incontinence is frequently a result of incomplete preoperative evaluation. Evaluation of surgical failures must include an assessment of urethral sphincter function by endoscopy, UCPP, or video-urodynamics. Patients with GSI and a mobile urethovesical junction and normal urethral closure pressure should be corrected by a Burch sling or MMK. Patients with low urethral closure pressure and normal or borderline UVJ mobility should have a suburethral sling procedure. Patients with a nonfunctioning urethral sphincter respond best to an artificial urinary sphincter.