Overview of Surgical Management of Urinary Incontinence

Purpose of Review Stress and urgency urinary incontinence are burdensome conditions that have large effects on the quality of life of patients, along with having a high-cost burden on the United States healthcare system. Though conservative therapies are first line, surgical management is an excellent option for when symptoms fail to improve. This review will summarize guideline-supported surgical techniques for urinary incontinence and discuss emerging therapies undergoing development. Recent Findings Guideline supported options for stress urinary incontinence include injection of bulking agents, midurethral slings, autologous fascial pubovaginal slings, and Burch colposuspension. Emerging therapies include single-incision slings and the use of vaginal lasers. For urgency urinary incontinence, surgical interventions include intradetrusor onabotulinumtoxinA injections, peripheral tibial nerve stimulation, and sacral neuromodulation. Newer innovative therapies are focused on pudendal or dorsal nerve neuromodulation and radiofrequency device therapy within the bladder. Summary There are numerous guideline supported surgical options present for stress and urgency urinary incontinence, with multiple being minimally invasive and having strong evidence for long-term efficacy. Future directions in the field are focused on creating therapies that have the ideal combination of having long-term efficacy, are cost-effective, minimally invasive, and with minimal side effects.