Surgical options in the treatment of stress urinary incontinence in women.

The aim of this review is to provide an update on the surgical options for treatment of stress incontinence in women. The efficiency of different procedures and the safety associated with each procedure are evaluated, mainly by reviewing the randomised controlled trials. The open retropubic colposuspension and the sling procedures are the most efficacious for treatment stress urinary incontinence especially in the long term. The laparoscopic colposuspension may be as good as the open colposuspension, but the long-term performance remains uncertain. The newer minimal access vaginal sling procedures appear to offer benefits of minimal access surgery with success rate similar to the colposuspension and the traditional slings and minor morbidity in the short and median-term. However long term data is still awaited. The transobturator technique does not seem to provide advantages compared to the classical TVT procedure. Urethral injection therapy does not seem to have the same efficacy as conventional surgery and long term data is still scanty. However, because of low operative morbidity it represents a favourable alternative to standard surgery in patients who prefer less invasive treatment, the frail elderly and other selected women where conventional surgery is problematic.