Prevalence, Diagnosis, and Management of Stress Urinary Incontinence in Women: A Collaborative Review

• Published in: European urology Vol. 87; no. 3; pp. 292 - 301
• Main Authors: Moris, Lisa, Heesakkers, John, Nitti, Victor, O’Connell, Helen E., Peyronnet, Benoit, Serati, Maurizio, Omar, Muhammad Imran, Harding, Chris
• Format: Journal Article
• Language: English
• Published: Switzerland Elsevier B.V 01.03.2025; Elsevier
• Subjects: Artificial urinary sphincter; Colposuspension; Female; Female incontinence; Humans; Life Sciences; Midurethral sling; Minimally invasive surgery; Pelvic floor muscle training; Prevalence; Stress urinary incontinence; Urinary Incontinence, Stress - diagnosis; Urinary Incontinence, Stress - epidemiology; Urinary Incontinence, Stress - therapy; Pelvic floor muscle training; Midurethral sling; Minimally invasive surgery; Artificial urinary sphincter; Female incontinence; Stress urinary incontinence; Colposuspension
• ISSN: 0302-2838; 1873-7560; 1873-7560; 1421-993X
• DOI: 10.1016/j.eururo.2024.12.017

This review emphasizes the importance of raising awareness about stress urinary incontinence (SUI) and improving access to a range of treatment options. Pelvic floor muscle training remains a pivotal first-line approach. Within the surgical field, single-incision slings present a recent advancement, offering comparable short-term effectiveness to standard midurethral slings (MUSs). However, concerns regarding mesh-related complications persist, resulting in a decline in the use of synthetic MUSs and underscoring the necessity for meticulous patient selection, and ongoing research endeavors to optimize outcomes. In the realm of complicated SUI, options such as autologous slings and artificial urinary sphincters are considered, although data on their comparative effectiveness remain limited. Continued research, careful patient selection, and long-term data collection are critical to optimizing treatment outcomes and ensuring patient safety. Stress urinary incontinence (SUI), defined as any involuntary leakage of urine associated with physical activity, remains underdiagnosed and undertreated. This review aims to provide an updated overview of the prevalence, diagnosis, and treatment of SUI in women, drawing upon recent evidence-based literature and clinical guidelines. A systematic search of the MEDLINE database was conducted to identify only the most up-to-date and relevant studies published up to February 26, 2024, including the reference ESTER systematic review. The search was limited to systematic reviews published in the preceding 1 yr. Any additional included publications were limited to those published or referenced as part of the existing/current guidelines. Diagnosis of SUI involves a comprehensive assessment, including medical history, physical examination, and in some cases, invasive urodynamics. Pelvic floor muscle training emerges as a first-line management strategy, showing efficacy in symptom improvement when good educational instructions and supervision are provided. Surgical interventions with midurethral and single-incision slings offer a second-line option, although concerns regarding mesh-related complications persist with a decrease in its use. Moreover, the long-term efficacy of single-incision slings remains to be confirmed. Urethral bulking agents, colposuspension, and autologous fascial slings are existing alternatives supported by robust evidence, albeit with a different adverse event profile. Management of complicated and severe SUI remains challenging, with autologous fascial sling and artificial urinary sphincters being established treatments, but high-quality data remain lacking. Heightened awareness and accessibility to SUI treatment are imperative to address the gap between prevalence and medical care–seeking behavior. Pelvic floor muscle training and surgical interventions represent key modalities. However, a notable escalation in invasiveness and complication rates when transitioning to surgical interventions is clear and has resulted in a hesitance among patients to proceed along the treatment continuum, particularly in light of mesh-related complications. Ongoing research is necessary to optimize outcomes and ensure patient safety, particularly for complicated SUI where data on comparative effectiveness remain limited.