Surgical Treatment of Female Stress Urinary Incontinence

1. In the initial evaluation of patients with stress urinary incontinence (SUI) desiring to undergo surgical intervention, clinicians should include the following components:

• History, including assessment of bother
• Physical examination, including a pelvic examination
• Objective demonstration of SUI with a comfortably full bladder (any method)
• Assessment of post-void residual urine (any method)
• Urinalysis

2. Clinicians should perform additional evaluations in patients being considered for surgical intervention who have the following conditions

• Inability to make definitive diagnosis based on symptoms and initial evaluation
• Inability to demonstrate SUI
• Known or suspected neurogenic lower urinary tract dysfunction
• Abnormal urinalysis, such as unexplained hematuria or pyuria
• Urgency-predominant mixed urinary incontinence (MUI)
• Elevated post-void residual per clinician judgment
• High grade pelvic organ prolapse (POP-Q stage 3 or higher) if SUI is not demonstrated with pelvic organ prolapse reduction
• Evidence of significant voiding dysfunction

3. Clinicians may perform additional evaluations in patients with the following conditions: (Expert Opinion)

• Concomitant overactive bladder symptoms
• Failure of prior anti-incontinence surgery
• Prior pelvic prolapse surgery