Surgical treatments (especially middle urethral suspension) for female stress urinary incontinence: a literature review

Background and Objective: Pelvic floor dysfunctions (PFDs) are increasingly prevalent worldwide. Among PFDs, stress urinary incontinence (SUI) stands out due to its complex pathogenesis, making it the most common form of urinary incontinence (UI), affecting at least 50% of adult women globally, particularly elderly and postpartum women. This condition leads to significant physical and psychological impairments. Surgical interventions have shown greater efficacy compared to conservative treatments, particularly in cases of severe SUI. Recent advancements in minimally invasive surgery have significantly improved surgical treatments, addressed associated side effects and achieved better therapeutic outcomes than in the past. Methods: A comprehensive literature search was conducted on PubMed, focusing on studies published from 2015 to 2022. Key Content and Findings: Mid -urethral slings (MUSs) have long been considered the preferred procedure for treating severe SUI. However, recent trials have suggested that single -incision slings (SISs) exhibit fewer side effects than traditional slings. Unfortunately, the efficacy and safety of SISs remain a subject of controversy due to limitations stemming from small sample sizes and short follow-up periods. To enhance postoperative outcomes, preoperative urodynamic reports have emerged as a valuable tool in identifying potential voiding dysfunctions (VDs). Conclusions: The paradigm of surgical treatment for SUI has evolved from anatomical restoration to providing support for defective structures. To optimize surgical outcomes, clinicians are advised to proactively identify high -risk factors associated with VD before the procedure. Furthermore, it is crucial to adequately inform patients about the potential need for postoperative indwelling catheters, thereby mitigating the risk of doctor -patient disputes.