Procedure selection in the management of stress urinary incontinence

Urinary incontinence, a very common problem among older women, is a source of considerable personal and social embarrassment to those who suffer from it, and a rather checkered history of failed procedures has led to an element of frustation to both patient and physician. One of the main reasons for this checkered history has been a philosophic approach to patient management: relying on the performance of simple procedures first, progressing to more elaborate procedures for failures but with little thought to the underlying etiology of the problem. This article discusses an approach to urinary incontinence in women in which the selection of a repair is based on the underlying etiology of the incontinence and the presence or absence of associated factors.