A 45-year-old multiparous woman leaks urine whenever she laughs, coughs, or exercises. Urodynamic testing shows urethral hypermobility and leakage with Valsalva at 150 mL bladder fill, with no detrusor overactivity. Maximum urethral closure pressure is 28 cmH₂O. Conservative management (pelvic floor exercises) has failed. The MOST appropriate surgical procedure is:

• A Burch colposuspension
• B Anterior colporrhaphy
• C Tension-free vaginal tape (TVT) — retropubic mid-urethral sling ✓
• D Periurethral bulking agents

Explanation

Tension-free vaginal tape (TVT) — a retropubic mid-urethral sling — is the current gold standard surgical treatment for stress urinary incontinence (SUI) with urethral hypermobility, based on the 'hammock' and 'integral theory'. It has > 80% long-term cure rates, is less invasive than Burch colposuspension (open/laparoscopic), and Cochrane meta-analyses confirm equivalent or superior efficacy to Burch. Anterior colporrhaphy has poor long-term results for SUI. Bulking agents are for intrinsic sphincter deficiency (low MUCP < 20 cmH₂O) or patients unfit for surgery.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.