Choice of surgery for stress incontinence.

OBJECTIVE

To outline the evidence for the efficacy of surgical procedures used for the primary treatment of urinary incontinence.

OPTIONS: The range of surgical options available for the primary treatment of urinary incontinence in women.

OUTCOMES: The best possible outcomes for women undergoing primary surgery for urinary incontinence. To provide a current understanding of the evidence available as the basis of an informed discussion of the anticipated outcome of surgery.

EVIDENCE: A systematic review of clinical trials of the outcomes of primary surgical treatment of urinary incontinence.

VALUES: The quality of the evidence is rated using the criteria described by the Canadian Task Force on periodic health examination (Table).

BENEFITS, HARMS, AND COSTS: Careful consideration of the surgical options available will result in informed choice, which is essential to the process of determining the most appropriate surgery for a woman. Use of a range of surgeries that have the highest proven efficacy is most likely to result in long-term patient satisfaction.