Women's Surgical Preferences in Stress Urinary Incontinence: Sling or Bulking Agent?

Area of Science:

• Urology
• Gynecology
• Pelvic Floor Disorders

Background:

• Stress urinary incontinence (SUI) significantly impacts women's quality of life.
• Conservative treatments like pelvic floor muscle training are often first-line therapies for SUI.
• A subset of women do not respond adequately to conservative management, necessitating second-line interventions.

Purpose of the Study:

• To evaluate the decision-making process for second-line treatments in women with SUI post-conservative therapy failure.
• To identify factors influencing the choice between bulking agents and surgical slings.
• To understand patient preferences regarding outcomes, recovery, and complications.

Main Methods:

• Observational study design.
• Inclusion of women with mild to moderate SUI unresponsive to rehabilitation.
• Comprehensive pre-treatment counseling detailing technique, hospitalization, recovery, outcomes, complications, and failure rates for both bulking agents and slings.

Main Results:

• Eighty women were evaluated.
• Women opting for bulking agents often lived alone, had demanding jobs requiring short absences, and experienced unavoidable physical exertion.
• Women choosing slings typically had less physically demanding jobs, were married with household support, and prioritized rapid return to activity.
• A significant majority (65%) selected bulking agents to mitigate complication risks.
• A substantial proportion (74.6%) of women choosing slings prioritized long-term efficacy.

Conclusions:

• Patient counseling is crucial for selecting appropriate second-line SUI treatments.
• Treatment choices are influenced by individual patient circumstances, including lifestyle, support systems, and personal priorities regarding recovery and long-term outcomes.
• Tailoring treatment recommendations to patient-specific needs and expectations enhances decision-making for second-line SUI management.