A 50-year-old woman with stress urinary incontinence and intrinsic sphincter deficiency (ISD) with a fixed, non-mobile urethra and low Valsalva leak point pressure (<60 cmH2O) is least likely to benefit from which procedure?

• A Retropubic colposuspension (Burch procedure)
• B Mid-urethral synthetic sling (TVT) ✓
• C Autologous rectus fascial pubovaginal sling
• D Periurethral bulking agents

Explanation

Mid-urethral synthetic slings (TVT/TOT) have lower success rates in intrinsic sphincter deficiency (ISD) with a fixed urethra because they rely on urethral mobility for the 'knuckle' mechanism. Pubovaginal slings are preferred for ISD as they provide a hammock-like support and urethral compression. Burch colposuspension also has reduced efficacy in ISD. Bulking agents are an option for poor surgical candidates with ISD.

Reference: Katzung's Basic and Clinical Pharmacology (Urology section) / Campbell-Walsh Urology, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.