European Urogynaecological Association Position Statement: Implantable Devices for Female Stress Incontinence Surgery

The European Urogynecological Association (EUGA) convened an expert group to address the surgical treatment of stress urinary incontinence (SUI) using implantable devices. Midurethral synthetic slings (MUS) remain the gold standard, demonstrating high efficacy and an acceptable safety profile. The choice of surgical approach should be tailored to individual patient needs and risk factors. Retropubic MUS may offer slightly higher efficacy but carry specific risks, while transobturator slings are associated with a higher incidence of chronic pelvic and groin pain. Single-incision mini-slings (SIMS) show promise, but further research is needed to establish their long-term efficacy and safety. EUGA emphasizes the importance of thorough patient counseling, including discussion of potential mesh-related complications and challenges of complete device removal. Alternative options, such as urethral bulking agents (UBA), may be considered for patients prioritizing minimal risk or in specific clinical scenarios, and are now adopted even as first-line treatment. The consensus underscores the need for proper patient stratification, comprehensive evaluation, and surgeon expertise in optimizing outcomes. The primary goal of surgical intervention should be to enhance the patient's quality of life. EUGA acknowledges ongoing scrutiny from regulatory bodies and stresses the importance of continued vigilance and research to ensure safe and effective use of surgical interventions for SUI. Currently, there is insufficient evidence to recommend the routine use of artificial urinary sphincters (AUS) in SUI treatment, and further robust data are required to define their role in this context.