Surgery for Stress Urinary Incontinence in Women — Improvement but Not a Cure

Historically, women who were considering surgery for stress urinary incontinence faced wide abdominal incisions, inpatient hospitalizations, and a 6-week recovery period. Two decades ago, the introduction of midurethral-sling procedures, which involve passing a small strip of polypropylene mesh under the urethra, resulted in shorter recovery than traditional procedures with similar efficacy. In the first generation of procedures, mesh was placed through the retropubic space. A second-generation approach passed the mesh through the obturator space, to minimize the risk of bowel or bladder injury with trocars inserted into the retropubic space. Extensive evidence, including from 81 trials involving 12,113 women, supports . . .