Evaluation and Management of Female Stress Urinary Incontinence

Female stress urinary incontinence, the loss of urine with transient increases in abdominal pressure, is a common condition that can profoundly impact a patient’s quality of life. The diagnosis is most commonly made via clinical history, including the subjective degree of bother, and physical examination evidence of urinary leakage with cough or Valsalva maneuver. A variety of treatment options exist for stress incontinence, ranging from observation, pelvic floor physical therapy, vaginal inserts, or continence pessaries to procedural interventions. Observation and conservative measures (eg, pads) can be used if the patient is not bothered by their symptoms. Nonsurgical management options include pelvic floor physical therapy, vaginal inserts, or continence pessaries. Procedural interventions include urethral bulking agent injection, synthetic mesh midurethral sling placement, autologous fascial pubovaginal sling placement, or retropubic colposuspension. Each procedure has a unique set of risks and benefits, with the choice of operation depending on a variety of factors including severity of stress incontinence, anatomy, medical and surgical comorbidities, and patient preferences. Ultimately, shared decision-making between the patient and the physician is used to decide the management strategy. This collaborative approach facilitates alignment of the chosen intervention with the patient's unique circumstances and preferences. We review relevant clinical considerations in the evaluation and management of female stress incontinence.