2025 AUGS Clinical Meeting-Evidence-based Surgical Treatment of SUI without the “Gold Standard” Synthetic Midurethral Sling

Evidence-based Surgical Treatment of SUI without the “Gold Standard” Synthetic Midurethral Sling

Video Transcription

Video Summary

The speaker in the video discusses various surgical treatments for stress urinary incontinence (SUI), particularly focusing on non-synthetic mesh options in response to patient concerns about the use of mesh. The discussion elaborates on the merits and drawbacks of procedures like autologous fascial slings and retropubic urethropexies (birch procedures). The speaker highlights a landmark study comparing these approaches, noting that while autologous fascial slings show better success rates, they do have higher rates of certain complications like voiding dysfunctions.<br /><br />Additionally, there's an overview of urethral bulking as an alternative, although the speaker suggests it's generally not as effective as slings and should not be considered a first-line treatment, especially for patients who want a durable solution. Emphasis is placed on understanding patient preferences, especially when they oppose mesh-based procedures despite its status as the gold standard for SUI treatment. The presentation calls for a balanced, evidence-based approach while considering patient preferences, especially in light of historical surgical approaches and the evolution of understanding of SUI pathophysiology.

Asset Subtitle

Most of us are very comfortable offering our patients a synthetic midurethral sling, but there are some patients that still don’t feel comfortable with mesh implantation. Learn about the other options for these patients.

Speaker - Holly E. Richter, PhD, MD, FACOG, FACS

Keywords

stress urinary incontinence

non-synthetic mesh

autologous fascial slings

retropubic urethropexies

urethral bulking

patient preferences

voicing dysfunctions

evidence-based approach