A 58-year-old multiparous woman presents with stress urinary incontinence (SUI). Urodynamic testing confirms urodynamic stress incontinence (USI) with urethral hypermobility. Conservative treatment (PFMT) for 3 months has failed. Which surgical procedure has the BEST long-term evidence (> 10 years) for cure of stress urinary incontinence?

• A Laparoscopic Burch colposuspension
• B Transobturator tape (TOT)
• C Periurethral bulking injection with hyaluronic acid
• D Tension-free vaginal tape (TVT) retropubic mid-urethral sling ✓

Explanation

Retropubic mid-urethral sling (TVT, tension-free vaginal tape) has the most robust long-term outcome data with cure rates of approximately 80–90% at 5 years and sustained efficacy at 10–17 years (Nilsson et al., 2013). Burch colposuspension has good long-term outcomes but slightly lower long-term durability than TVT. Transobturator tape (TOT) has comparable short-term outcomes but less robust data at > 10 years. Bulking agents have high recurrence rates and are reserved for those unfit for surgery. TVT is the reference standard for SUI surgery.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.