Stress Urinary Incontinence (SUI) affects 35%-40% of women worldwide 1,2 , it occurs when a woman experiences involuntary leakage of urine during physical activities that increase intra-abdominal pressure such as exercise, cough, sneeze, or laugh 3 . Risk factors include age, parity, pregnancy, vaginal delivery, chronic cough, constipation, obesity, pelvic floor weakness, post-menopausal state and prior pelvic surgery.
SUI can significantly affect the quality of life since women may avoid certain activities or exercises that cause leakage or they may be embarrassed to go out in public due to fear of leakage.
The ideal treatment for SUI is a therapy that is effective at relieving symptoms, one that is minimally invasive, nearly painless, durable and would restore normal urethral supportive function.
Currently, the main treatment options for SUI consist of a vaginal approach and placement of a synthetic midurethral slings (MUS), a biologic bladder neck sling or urethral bulking agents. However, there are limitations to slings and not every patient with SUI may be a candidate for one. Some patients may require a tight bladder neck slings which can be associated with urgency-frequency, obstructive voiding and post-operative pain, especially if autologous fascia is used. Urethral bulking agents are minimally invasive but durability is lacking and repeat injections are typically necessary.
The synthetic MUS may carry its own unique set of risks, including mesh exposure, mesh erosion into surrounding organs, dyspareunia, pelvic pain, and need for further surgery. Despite the proven safety and efficacy of mesh MUS, an aggressive mesh MUS legal environment exists, thus the ideal treatment of SUI is still lacking.
