A critical overview of the evidence base for the contemporary surgical management of stress incontinence.

Objective: The purpose of this article is to evaluate the evidence base for surgical management of stress urinary incontinence in women between July 2006 and December 2007.

Results: The Urinary Incontinence Treatment Network and Pelvic Floor Diseases Network have contributed level 1 evidence in the management of stress urinary incontinence with multicentric randomized controlled trials. Pubovaginal sling has a higher success rate than the Burch at the expense of a higher morbidity. A prophylactic Burch procedure at the time of an abdominal sacrocolpopexy can reduce secondary stress urinary incontinence and urge urinary incontinence. Suburethral tapes have a higher cure rate for patients with predominant stress urinary incontinence and can safely be placed at the time of concomitant pelvic surgery. The tension-free vaginal tape has a higher rate of lower urinary tract injury and voiding dysfunction when compared with transobturator tape.

Conclusions: The Burch and pubovaginal sling have a high success rate for treating stress urinary incontinence. Prospective randomized trials are needed to assess the long-term results of suburethral slings. There is still no consensus on outcome measures when reporting on surgical management for stress urinary incontinence.