SURGICAL MANAGEMENT OF FEMALE STRESS URINARY INCONTINENCE: A CONTEMPORARY NARRATIVE REVIEW OF MID-URETHRAL SLINGS, BURCH COLPOSUSPENSION, AUTOLOGOUS FASCIAL SLINGS, AND BULKING AGENTS

Kristian Bjorgen; Lilianna Jasińska; Magdalena  Roman; Martyna Lipiarz; Michał Niespodziewański; Patrycja Szczygielska; Sylwia Hejna; Weronika Smutkiewicz; Weronika Teterycz; Wiktoria Goździejewska

doi:10.31435/ijitss.3(51).2026.5877

Authors

Kristian Bjorgen Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland https://orcid.org/0009-0008-0225-7439
Lilianna Jasińska University of Warmia and Mazury in Olsztyn, Olsztyn, Poland https://orcid.org/0009-0006-0819-8922
Magdalena Roman Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland https://orcid.org/0009-0004-1261-180X
Martyna Lipiarz Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland https://orcid.org/0009-0001-3124-9250
Michał Niespodziewański Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland https://orcid.org/0009-0009-0937-1549
Patrycja Szczygielska Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland https://orcid.org/0009-0006-2063-3165
Sylwia Hejna Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland https://orcid.org/0009-0005-6313-3067
Weronika Smutkiewicz Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland https://orcid.org/0009-0007-4965-1903
Weronika Teterycz Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland https://orcid.org/0009-0000-7486-458X
Wiktoria Goździejewska Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland https://orcid.org/0009-0007-5302-1883

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.5877

Keywords:

Colposuspension; Mid-Urethral Sling; Bulking Agents; Autologous Fascial Slings; Stress Urinary Incontinence

Abstract

Introduced at the tail end of the twentieth century, mid-urethral slings (MUS) have established themselves as the premier global paradigm for the surgical correction of stress urinary incontinence (SUI) in women. Longitudinal evidence substantiates that the therapeutic outcomes of MUS align closely with historical benchmarks, including Burch colposuspension and autologous fascial slings. Even though minimally invasive modalities like urethral bulking agents are experiencing a surge in adoption, debates persist regarding the optimal MUS approach; while retropubic techniques offer enhanced long-term robustness especially in complicated presentations featuring intrinsic sphincter deficiency (ISD) or previous treatment failures transobturator tape (TOT) continues to see widespread clinical application due to exceptionally positive patient-reported outcomes.[1] Consequently, selecting the most appropriate surgical route necessitates a careful, individualized risk-benefit assessment, balancing the structural longevity of retropubic procedures against the excellent tolerability and satisfaction rates frequently associated with the transobturator approach in contemporary urogynecological practice. Furthermore, this article focuses on the surgical techniques per se and pathophysiology of stress urinary incontinence to provide a clearer explanation of the various operative procedures.

Methods: This review article was written using a literature review of the PubMed database (2019-2026). It focuses on pathophysiology and surgical management of Female Stress Urinary Incontinence.

References

Karmakar, D. (2019). Surgical management of urinary stress incontinence—Where are we now? Best Practice & Research Clinical Obstetrics & Gynaecology, 54, 31–40. https://doi.org/10.1016/j.bpobgyn.2018.10.003

Lugo, T., Leslie, W. S., Mikes, B. A., & Riggs, J. (2026). Stress urinary incontinence. In StatPearls. StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/30969591/

Veit-Rubin, N., Dubuisson, J., Ford, A., Dubuisson, J.-B., Mourad, S., & Digesu, A. (2019). Burch colposuspension. Neurourology and Urodynamics, 38(2), 553–562. https://doi.org/10.1002/nau.23905

Jefferson, F. A., & Linder, B. J. (2024). Evaluation and management of female stress urinary incontinence. Mayo Clinic Proceedings, 99(11), 1802–1814. https://doi.org/10.1016/j.mayocp.2024.07.003

American College of Obstetricians and Gynecologists, & American Urogynecologic Society. (2014). Committee Opinion No. 603: Evaluation of uncomplicated stress urinary incontinence in women before surgical treatment. Obstetrics & Gynecology, 123(6), 1403–1407. https://doi.org/10.1097/01.AOG.0000450756.24422.38

Yang, X., Wang, X., Gao, Z., Li, L., Lin, H., Wang, H., Zhou, H., Tian, D., Zhang, Q., & Shen, J. (2023). The anatomical pathogenesis of stress urinary incontinence in women. Medicina, 59(1), 105.

Cundiff, G. W. (2004). The pathophysiology of stress urinary incontinence: A historical perspective. Reviews in Urology, 6(Suppl. 3), S10–S18. https://pmc.ncbi.nlm.nih.gov/articles/PMC1472864/

Alshiek, J., Garcia, B., Minassian, V., Shobeiri, S. A., Al-Mandeel, H., Al-Badr, A., et al. (2015). Burch colposuspension: An up-to-date review. Female Pelvic Medicine & Reconstructive Surgery, 21(6), 354–361.

Dean, N., Ellis, G., Herbison, G. P., Wilson, D., & Mashayekhi, A. (2017). Laparoscopic colposuspension for urinary incontinence in women. Cochrane Database of Systematic Reviews, 2017(7), Article CD002239. https://doi.org/10.1002/14651858.CD002239.pub4

Dumville, J. C., Manca, A., Kitchener, H. C., Smith, A. R. B., Nelson, L., & Torgerson, D. J. (2006). Cost-effectiveness analysis of open colposuspension versus laparoscopic colposuspension in the treatment of urodynamic stress incontinence. BJOG: An International Journal of Obstetrics & Gynaecology, 113(9), 1014–1022. https://doi.org/10.1111/j.1471-0528.2006.01036.x

Goldman, H. B. (2022). Joint position statement on midurethral slings for stress urinary incontinence. Neurourology and Urodynamics, 41(1), 31–34. https://doi.org/10.1002/nau.24838

Richter, H. E., Albo, M. E., Zyczynski, H. M., Kenton, K., Norton, P. A., Sirls, L. T., Kraus, S. R., Chai, T. C., Lemack, G. E., Dandreo, K. J., Varner, R. E., Menefee, S., Ghetti, C., Brubaker, L., Nygaard, I., Khandwala, S., Rozanski, T. A., Johnson, H., Schaffer, J., . . . Urinary Incontinence Treatment Network. (2010). Retropubic versus transobturator midurethral slings for stress incontinence. The New England Journal of Medicine, 362(22), 2066–2076. https://doi.org/10.1056/NEJMoa0912658

Kenton, K., Stoddard, A. M., Zyczynski, H., Albo, M., Rickey, L., Norton, P., Wai, C., Kraus, S. R., Sirls, L. T., Kusek, J. W., Litman, H. J., Chang, R. P., & Richter, H. E. (2015). 5-year longitudinal followup after retropubic and transobturator mid urethral slings. The Journal of Urology, 193(1), 203–210. https://doi.org/10.1016/j.juro.2014.08.089

Muller, P., Gurol-Urganci, I., van der Meulen, J., Thakar, R., & Jha, S. (2021). Risk of reoperation 10 years after surgical treatment for stress urinary incontinence: A national population-based cohort study. American Journal of Obstetrics and Gynecology, 225(6), 645.e1–645.e14. https://doi.org/10.1016/j.ajog.2021.08.059

Labrie, J., Berghmans, B. L. C. M., Fischer, K., Milani, A. L., van der Wijk, I., Smalbraak, D. J. C., Vollebregt, A., Schellart, R. P., Graziosi, G. C. M., van der Ploeg, J. M., Brouns, J. F. G. M., Tiersma, E. S. M., Groenendijk, A. G., Scholten, P., Mol, B. W., & Blokhuis, E. E. (2013). Surgery versus physiotherapy for stress urinary incontinence. The New England Journal of Medicine, 369(12), 1124–1133. https://doi.org/10.1056/NEJMoa1210627

Gurol-Urganci, I., Geary, R. S., Mamza, J. B., Duckett, J., El-Hamamsy, D., Dolan, L., Tincello, D. G., & van der Meulen, J. (2018). Long-term rate of mesh sling removal following midurethral mesh sling insertion among women with stress urinary incontinence. JAMA, 320(16), 1659–1669. https://doi.org/10.1001/jama.2018.14997

Dejene, S. Z., Funk, M. J., Pate, V., & Wu, J. M. (2022). Long-term outcomes after midurethral mesh sling surgery for stress urinary incontinence. Female Pelvic Medicine & Reconstructive Surgery, 28(4), 188–193. https://doi.org/10.1097/SPV.0000000000001094

McGuire, E. J., Bennett, C. J., Konnak, J. A., Sonda, L. P., & Savastano, J. A. (1987). Experience with pubovaginal slings for urinary incontinence at the University of Michigan. The Journal of Urology, 138(3), 525–526. https://doi.org/10.1016/S0022-5347(17)43246-0

Bretschneider, C. E., Geynisman-Tan, J., Mueller, M. G., Collins, A. S., Lewicky-Gaupp, C., & Kenton, K. (2021). Rates of sling procedures and revisions—A National Surgical Quality Improvement Program database study. Female Pelvic Medicine & Reconstructive Surgery, 27(6), e559–e562. https://doi.org/10.1097/SPV.0000000000000995

Kobashi, K. C., Albo, M. E., Dmochowski, R. R., Arts, D. A., Goldman, H. B., Gomelsky, A., Kraus, S. R., Sandhu, J. S., Shepler, T., Treadwell, J. R., Vasavada, S., & Lemack, G. E. (2017). Surgical treatment of female stress urinary incontinence: AUA/SUFU guideline. The Journal of Urology, 198(4), 875–883. https://doi.org/10.1016/j.juro.2017.06.061

Sharma, J. B., Deoghare, M. K., Bhatla, N., Kachhawa, G., Mahey, R., & Kumari, R. (2020). A comparative study of autologous rectus fascia pubovaginal sling surgery and synthetic transobturator vaginal tape procedure in treatment of women with urodynamic stress urinary incontinence. European Journal of Obstetrics & Gynecology and Reproductive Biology, 252, 349–354. https://doi.org/10.1016/j.ejogrb.2020.06.062

Fusco, F., Abdel-Fattah, M., Chapple, C. R., Creta, M., La Falce, S., Waltregny, D., & Novara, G. (2017). Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary incontinence. European Urology, 72(4), 567–591. https://doi.org/10.1016/j.eururo.2017.04.026

Braga, A., Caccia, G., Papadia, A., Treglia, G., Castronovo, F., Salvatore, S., Torella, M., Ghezzi, F., & Serati, M. (2022). Urethral bulking agents for the treatment of recurrent stress urinary incontinence: A systematic review and meta-analysis. Maturitas, 163, 28–37. https://doi.org/10.1016/j.maturitas.2022.05.007

Hoe, V., Haller, B., Yao, H. H., & O’Connell, H. E. (2021). Urethral bulking agents for the treatment of stress urinary incontinence in women: A systematic review. Neurourology and Urodynamics, 40(6), 1349–1388. https://doi.org/10.1002/nau.24696

Itkonen Freitas, A. M., Isaksson, C., Rahkola-Soisalo, P., Tulokas, S., Mentula, M., & Mikkola, T. S. (2022). Tension-free vaginal tape and polyacrylamide hydrogel injection for primary stress urinary incontinence: 3-year followup from a randomized clinical trial. The Journal of Urology, 208(3), 658–667. https://doi.org/10.1097/JU.0000000000002720