Evolution of stress urinary incontinence (SUI) outcomes assessment: a narrative review

Stress urinary incontinence (SUI), the most common type of incontinence in women, is the involuntary loss of urine during physical exertion or moments of increased intra-abdominal pressure such as coughing or sneezing. Numerous clinical studies have compared the long-term safety and efficacy of autologous fascial slings, Burch colposuspension, and synthetic mid-urethral slings (MUS). As the data from these comparative studies has matured over the last 20 years, a universally accepted definition of success remains elusive. This absence of a standardized measure not only compromises inter-center comparison but also impedes the ability of urologists to accurately interpret outcomes of sling procedures and provide patients with informed care. This review aims to examine the characterization of "cure" through the evolution of anti-incontinence surgery as well as to challenge the currently nebulous definition of success.

A comprehensive literature search on PubMed and Web of Science was conducted between September 2023 to February 2024 using the keywords: "stress urinary incontinence", "female", "success", "cure", "outcome", "surgical", and "sling". Select articles focusing on defining success through specific outcome measures and efficacy of surgical interventions were included in this narrative review.

Definitions of success are currently specific only to the exact center and urology group who performed the procedure, thus making comparison amongst centers virtually impossible. Success ranges not only from objective to subjective but more importantly, from lenient to strict. Most common objective factors were negative cough stress test, negative pad test, and absence of SUI retreatment versus reduced degree of bother and improved questionnaire scores for subjective success.

The heterogeneity of definitions of success for SUI surgery outcomes remains a persistent challenge. Even more worrisome is the realization that this diversity is not a recent revelation; studies from the early 2000s highlighted this incongruity, emphasizing a long overdue need for correction.