Surgical interventions for stress urinary incontinence

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 …