Stress urinary incontinence

Abstract Stress urinary incontinence (SUI) is a common condition accounting for around 50% of all female urinary incontinence. Diagnosis includes robust history taking, clinical examination including cough stress test, urinalysis, and post-void residual measurement. For uncomplicated primary SUI, guidelines advise that urodynamic studies are not required, although clinicians may offer this test to assist with patient counselling. Management of primary SUI includes conservative measures with bladder training, supervised pelvic floor muscle training, and weight loss. Surgical options comprise urethral bulking agents, mid-urethral tapes (currently on ‘pause’ in the UK), autologous fascial slings, and colposuspension. Approximately 20–30% fail primary treatment for SUI with recurring incontinence which can be more difficult to treat. Urodynamics is essential in this setting. All surgical options can be offered again, and insertion of an artificial urinary sphincter. For end-stage complex SUI, surgical management is limited to artificial urinary sphincter or urinary diversion. Clear patient counselling on the treatment options and associated risks is essential.