A 45-year-old woman complains of urinary leakage with coughing and sneezing for 2 years. Urodynamic studies show urethral hypermobility with a leak-point pressure of 55 cmH₂O and no detrusor overactivity. What is the first-line surgical treatment?

• A Burch colposuspension
• B Periurethral bulking agent injection
• C Mid-urethral sling (tension-free vaginal tape, TVT) ✓
• D Artificial urinary sphincter implantation

Explanation

Mid-urethral slings (tension-free vaginal tape — TVT retropubic, or TVT-O transobturator) are the gold-standard surgical treatment for stress urinary incontinence due to urethral hypermobility. They achieve ~85–90% cure rates. Burch colposuspension is an alternative open or laparoscopic procedure with comparable long-term efficacy but is more invasive. Bulking agents have lower cure rates (~50%) and are reserved for women who decline or cannot tolerate sling surgery. Artificial sphincter is for intrinsic sphincter deficiency or failed sling.

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

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