Application of the concept of 'therapeutic index' to surgery for stress incontinence.

The pharmacologic concept of therapeutic index can be applied to surgery for stress incontinence to obtain an objective prediction of surgical outcome. The rationale and mechanics of its application to surgery are discussed in this article. The conclusions support current clinical trends which favor discarding the anterior repair and needle suspension procedures as first-line surgical treatment of stress urinary incontinence in favor of the retropubic procedures. Suburethral sling procedures should be, as now, reserved for second-line surgical treatment of stress urinary incontinence.