Surgery for Stress Urinary Incontinence in Women — Improvement but Not a Cure

This editorial discusses the evolution of surgical treatments for stress urinary incontinence (SUI) in women, focusing on midurethral slings and the newer mini sling procedures. The authors highlight the high short  to medium term effectiveness and safety of midurethral slings, supported by extensive clinical evidence. They also address concerns about transvaginal mesh kits for pelvic organ prolapse, which led to regulatory restrictions, while noting that mesh slings for SUI remain widely used in the U.S. The article reviews a pragmatic trial comparing mininslings (single incision, less invasive) to traditional midurethral slings, finding comparable patient reported success rates but higher rates of dyspareunia and repeat surgery with mini slings. Despite improvements, fewer than one third of women achieved a complete "cure" (no urinary leakage) at 36 months. The authors emphasize the importance of patient specific considerations when choosing surgical options and underscore the need for continued research to refine SUI treatments.

This editorial discusses the evolution of surgical treatments for stress urinary incontinence (SUI) in women, focusing on midurethral slings and the newer mini sling procedures. The authors highlight the high short  to medium term effectiveness and safety of midurethral slings, supported by extensive clinical evidence. They also address concerns about transvaginal mesh kits for pelvic organ prolapse, which led to regulatory restrictions, while noting that mesh slings for SUI remain widely used in the U.S. The article reviews a pragmatic trial comparing mininslings (single incision, less invasive) to traditional midurethral slings, finding comparable patient reported success rates but higher rates of dyspareunia and repeat surgery with mini slings. Despite improvements, fewer than one third of women achieved a complete "cure" (no urinary leakage) at 36 months. The authors emphasize the importance of patient specific considerations when choosing surgical options and underscore the need for continued research to refine SUI treatments.