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SUI Surgery Pathway
Bothersome SUI not responding to conservative treatment |
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Colposuspension
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Mid-Urethral sling
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Pubovaginal sling |
Mini-sling |
Retropubic tape |
Obturator tape |
Preferred Option 
Possible Pathway 
Further Data Required 
Surgical Treatment Female Stress Urinary Incontinence |
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| Those with complicated incontinence (recurrent, post radiation, fixed urethra) need individualised care. | GoR |
Surgical OptionsColposuspension |
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| Superior outcomes to anterior repair, MMK and needle suspensions | A |
| Similar outcomes to pubovaginal slings with less morbidity | B |
| Outcomes similar or slightly less than synthetic Mid Urethral Slings (MUS) however longer operating time and recovery, slower return to activities of daily living and more prolapse in medium term | B |
| Laparoscopic approach when performed same technique as open has similar success rate with less morbidity than open approach | B |
| Consider in those wishing to avoid mesh procedure |
Surgical OptionsPubovaginal sling |
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 |
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| Limited data comparing to MUS | B |
| Demonstrated similar outcomes however pubovaginal sling greater lower urinary tract symptoms and reoperation than MUS. The MUS had higher rate of bladder perforation | B |
| When compared to colposuspension outcomes similar except higher voiding dysfunction following pubovaginal slings | B |
| Consider in those wishing to avoid mesh procedure |
Surgical OptionsMid-urethral sling |
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| Recommended surgical treatment female SUI | A |
| The most extensively researched option for SUI establishing efficacy and safety profile | A |
| As effective or more effective than colposuspension or pubovaginal sling with less perioperative and post-operative morbidity | B |
| Include retropubic, transobturator or minislings |
Mini-slings |
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| Many of these products removed from the market by manufacturers | C |
| Very limited data on outcomes of those that remain on the market | C |
| Until further data available consider use in audit environment with ethics committee oversight | C |
Retropubic versus transobturator mid-urethral sling |
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| In short-term retropubic and obturator tapes have similar outcomes with the obturator tape being slightly quicker to perform (few minutes quicker). | A |
| However in the medium term (>5 years) the reoperation for recurrent SUI greater in obturator group and a small number develop groin pain (3-4%) that is difficult to treat. | A |
| Retropubic considered as the preferred procedure with transobturator reserved for those patients with a hostile abdomen and in those at increased risk of bleeding (medications such as asprin or warfarin). | C |