A 40-year-old woman with stress urinary incontinence demonstrates a positive cough stress test and urethral hypermobility. Urodynamics confirm urodynamic SUI without detrusor overactivity. After failure of pelvic floor muscle training for 3 months, the procedure of choice with the strongest evidence for surgical cure is:

• A Burch colposuspension
• B Mid-urethral sling (tension-free vaginal tape — TVT) ✓
• C Periurethral bulking agent injection
• D Anterior colporrhaphy

Explanation

Mid-urethral sling procedures (TVT, TOT) are the surgical gold standard for uncomplicated urodynamic stress incontinence, with 5-year cure rates of 80–90%. The retropubic TVT and transobturator TOT have equivalent efficacy; TVT has a slight advantage in intrinsic sphincter deficiency. Burch colposuspension has similar cure rates but greater morbidity and longer recovery. Anterior colporrhaphy has high recurrence rates for SUI and is not recommended as a primary SUI procedure.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.