Intended for healthcare professionals


Surgical interventions for stress urinary incontinence

BMJ 2019; 365 doi: (Published 05 June 2019) Cite this as: BMJ 2019;365:l2350

Linked research

Surgical interventions for women with stress urinary incontinence

Linked opinion

What next for transvaginal mesh?

  1. Emily Carter, Cochrane fellow1,
  2. Rufus Cartwright, subspecialty trainee urogynaecology2
  1. 1Cochrane UK, Oxford, UK
  2. 2John Radcliffe Hospital, Oxford OX3 8HU, UK
  1. Correspondence to: R Cartwright rufus.cartwright{at}

Women and surgeons must navigate a challenging landscape of choices

Stress urinary incontinence—defined as leaking urine with coughing, sneezing, or exertion—affects more than one in 10 adult women,1 and represents a large unmet health need. The linked systematic review and network meta-analysis by Imamura and colleagues (doi:10.1136/bmj.l1842) includes and updates eight earlier Cochrane reviews, to provide a unified summary of comparative efficacy and safety for all contemporary surgical procedures for stress incontinence.2

From the late 1990s, there has been a rapid progression in surgical techniques for management of stress incontinence. The advent of the polypropylene midurethral sling seemed to many surgeons like a revolutionary advance, compared with earlier and more invasive options such as open colposuspension and native tissue fascial slings. The midurethral sling was a technically simple day-case procedure, with excellent efficacy rates and seemingly lower morbidity than previous procedures. It rapidly became the most widely offered procedure in many countries,3 and with its popularity, overall …

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