A 45-year-old woman with stress urinary incontinence (SUI) is found to have urethral hypermobility but no intrinsic sphincter deficiency (ISD) on urodynamics. After conservative physiotherapy failure, the surgical procedure with highest long-term cure rate is:

• A Burch colposuspension (retropubic)
• B Urethral bulking agents (periurethral injection)
• C Anterior colporrhaphy (anterior repair)
• D Tension-free vaginal tape (TVT — retropubic midurethral sling) ✓

Explanation

Retropubic midurethral slings (TVT — tension-free vaginal tape by Ulmsten) have replaced Burch colposuspension as the current gold-standard for surgical treatment of SUI in women with urethral hypermobility, with 5-year objective cure rates of 80–90%. Randomized trials (including the Ward & Hilton RCT) show comparable efficacy between TVT and Burch, but TVT has significantly shorter operative time, hospital stay, and recovery. Bulking agents are suitable for ISD or women unfit for surgery but have lower long-term durability. Anterior colporrhaphy addresses cystocele but not SUI specifically.

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

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Written and medically reviewed by the StethoPrep medical team.