Management of female stress urinary incontinence: A care pathway and update

Stress urinary incontinence (SUI) is a condition characterized by an involuntary loss of urine occurring as result
of an increase in intra-abdominal pressure due to effort or exertion or on sneezing or coughing. Estimates of its
prevalence in the female population range from 10% to 40%.
A literature search of the Medline, Cochrane library, EMBASE, NLH, ClinicalTrials.gov and Google Scholar
databases was done up to July 2017, restricted to English-language articles, using terms related to SUI, medical
therapy, surgical therapy and treatment options. The search terms included female stress urinary incontinence,
mid-urethral sling, tension-free vaginal tape (TVT) and transobturator tape (TOT, TVT-O). Original articles,
reviews and meta-analyses were included.
Surgical therapy should be considered only after conservative therapies (e.g. an exercise programme or topical
estrogens) have failed. Synthetic mid-urethral slings are the gold standard for the surgical treatment of SUI
according to the 2016 guidelines of the European Society of Urology (ESU) and the 2017 position statement of
the European Urogynaecological Association (EUA).
The therapeutic options are numerous but further research into new therapeutic strategies is needed to
achieve a better balance between efficacy and adverse events.