Abstract

Any complaint of involuntary leakage of urine with increased abdominal pressure is called as Stress urinary incontinence (ICS2010) Stress urinary incontinence is a condition which affect badly the quality of life of the patient. A number of surgical procedures are there but still lack of randomized control trial, keeps treatment of choice in dilemma. There are various subjective and objective tests are available to assess the severity of SUI. Most common objective test to assess SUI is Urodynamic study (UDS) and the subjective one is bladder diary. Amongst the investigation urine analysis, post void residual urine volume is important. UDS is only recommended in complicated SUI cases like mixed incontinence, voiding dysfunction, apical prolapse, failed surgery (Urinary incontinence) and pelvic organ prolapse in women. In mild cases we should try conservative treatment first. Candidates for incontinence surgery are those having inadequate response to conservative treatment. SUI can be treated with surgery performed vaginally or abdominally. The ancient procedures like anterior colporrhaphy with Kelly’s procedure as a treatment for SUI have 38% treatment failure rate, transabdominal paravaginal repair had 20-57% failure rate, transvaginal needle suspension like Pereyra, Stamey, Raz, or Gitte’s procedures, referred to as needle urethropexy has higher recurrence rate even after 1 year so all these procedures are obsolete now a days. For urethral hypermobility and bladder neck descent retropubic urethropexy like Burch are better and for Intrinsic sphincter deficiency Suburethral slings like Autologous fascial slings are more effective. MUS at present the most common SUI procedure. Pubovaginal slings are reserved for those patients in which MUS are contraindicated or was unsuccessful. Clinicians should inform the patient regarding appropriate surgical options before treatment decisions are made. AFS have more success rate with more complications also.