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Praxis 2017; 106: 1– 8
https://doi.org/10.1024/1661-8157/a002843
© 2017 Hogrefe Distributed under the
Hogrefe OpenMind License (http://dx.doi.org/10.1026/a000002)
Mini-Review 1
Current Treatment Concepts for
Stress Urinary Incontinence
Aktuelle Behandlungskonzepte bei Belastungsinkontinenz
Oliver Rautenberg1, Irena Zivanovic1, Jacek Kociszewski2, Andrzej Kuszka2, Julia Münst1,
Lilly Eisele1, Nicole Viereck1, Claudia Walser1, Marianne Gamper1 and Volker Viereck1
1 Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, 8501 Frauenfeld, Switzerland
2 Department of Gynecology and Obstetrics, Lutheran Hospital Hagen-Haspe, 58135 Hagen, Germany
Abstract: Initially, stress urinary incontinence should be treated by conservative measures, such as weight reduction, hormo-
nal substitution, physiotherapy, pelvic floor exercise and/or the use of pessaries. Incontinence surgeries are only recommend-
ed in case of unsuccessful conservative therapy. Today, tension-free suburethral sling insertions represent the gold standard
of incontinence surgery yielding very good outcomes (cure rates of 80–90 %). Pelvic-floor sonography provides important infor-
mation on decision of surgical methods and the management of complications. Furthermore, intra- or paraurethral injection of
bulking agents is a promising, minimally invasive surgical alternative. This article discusses treatment concepts, pre-, intra-
and post-operative examinations, decision on surgical methods, operational details for surgical success, and the prevention
and management of complications.
Keywords: Suburethral sling, incontinence surgery, bulking agents, tape mobilization, pelvic floor sonography
Zusammenfassung: Eine Belastungsinkontinenz sollte immer zuerst konservativ behandelt werden. Schon eine Gewichtsre-
duktion, Hormonpräparate, Physiotherapie, Beckenbodentraining und/oder die Anwendung von Pessaren können zum Erfolg
führen. Nach Ausschöpfen dieser Therapien werden heute Inkontinenzoperationen mit meist sehr guten Heilungschancen (ca.
80–90 %) angeboten. Der operative Goldstandard ist die suburethrale Schlingeneinlage. Die Pelvic-Floor-Sonografie liefert
dazu sehr wichtige Hinweise zur Wahl der Operationstechnik und zur Behebung von Komplikationen. Ferner bildet die intra-
oder paraurethrale Injektion von Bulking Agents eine vielversprechende, wenig invasive operative Alternative. In diesem Artikel
werden Behandlungskonzepte, prä-, intra- und postoperative Untersuchungen, Wahl der Operationsmethode, operationstech-
nische Details für den Operationserfolg sowie Vorbeugung und Behandlung von Komplikationen diskutiert.
Schlüsselwörter: Suburethrale Schlinge, Inkontinenzoperation, Bulking Agents, Bandlockerung, Pelvic-Floor-Sonografie
Résumé: En première intention, l'incontinence urinaire doit être traitée par des mesures non invasives, telles que la réduction
de poids, la substitution hormonale, la physiothérapie, l'exercice du plancher pelvien et/ou l'utilisation de pessaires. Après
avoir épuisé toutes ces thérapies, la chirurgie de l'incontinence offre de très bons résultats. Aujourd'hui, la bandelette synthé-
tique sous urétrale représente l'intervention de référence (ou gold standard) de la chirurgie de l'incontinence avec un taux de
guérison de 80–90 %. L'échographie pelvienne fournit des informations importantes sur la décision des méthodes chirurgi-
cales et la prise en charge des complications. En outre, l'injection d'agents comblants intra- ou para-urétrale offre une alter-
native chirurgicale prometteuse et moins invasive. Cet article discutera des concepts de traitement, des examens pré-, per- et
post-opératoires, du choix des méthodes chirurgicales, des détails techniques pour la réussite chirurgicale, et de la prévention
et du traitement des complications.
Mots-clés: Bandelette sous urétrale; chirurgie de l'incontinence; des agents comblants; mobilisation de la bandelette; écho-
graphie pelvienne
Introduction
Urinary incontinence is dened as an involuntary loss of
urine. It is not an independent disease, but a symptom of
various etiologies with dierent disease severities [1].
Urinary incontinence often leads to social exclusion and
a signicant restriction in quality of life. In Switzerland,
Abbreviations:
E2: Estradiol
E3 Estriol
PAHG Polyacrylamide hydrogel
TVT Retropubic tension-free vaginal tape
TOT Transobturator vaginal tape
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2 Mini-Review
approximately 400,000 women are aected [2]. Stress
urinary incontinence representing 60 % of all cases is the
most frequent form of incontinence [3]. Five to 20 % of
all women are aected [4] whereby this percentage con-
tinuously increases with age.
Stress urinary incontinence is characterized by an in-
voluntary loss of urine due to physical activities, with an
increased intra-abdominal pressure, but without an uro-
dynamically diagnosed detrusor instability [5–7]. In this
case, the urethral closure mechanism, eective by the
urethral closure pressure at rest and the pressure trans-
mission during physical activity, cannot withstand the
actual increase of intra-abdominal pressure [8]. Depen-
ding on the severity of stress urinary incontinence du-
ringphysical straining, leakage may be as little as a drop
or two, or may be a “squirt,” or even a stream of urine
(Fig. 1-A).
Numerous studies [9, 10] conrmed the integral theory
by Ulmsten and Petros [11] that suggested causes for the
decrease in urethral closure pressure. These six anatomical
structures are likely to be involved: Dysfunction in the re-
gion of bladder neck or striated muscles, loosening of the
ligamenta sacrouterina and the attachment site of the pubo-
coccygeus muscle, insuciency of the pubourethralia liga-
ment and the suburethrally situated vaginal wall. According
to Ulmsten and Petros, the two last-mentioned structures
are most important for correct functioning. Factors that
lead to weakening of muscle and connective tissue in the
pelvic oor area are increasing atrophy of the urethral mu-
cosa after postmenopausal estrogen deciency, a decrease
in vascularization, pregnancy, childbirth, obesity, and a se-
vere intra-abdominal pressure increase by chronic cough or
constipation [1,12].
The integral theory provided the base for the develop-
ment of the suburethral sling insertion technique. In the
mid-1990s, this new operative approach revolutionized in-
continence surgery [13]. Continence was achieved by the
tension-free support of the midurethra by a synthetic poly-
propylene tape (TVT) [14, 15]. Today, this method is the
gold standard for the treatment of stress urinary inconti-
nence (Fig.
1-B).
Conversely, the more invasive colposuspension tech-
nique (Fig.
1-C), the former gold standard, is rarely used,
and typically, in combination with a laparoscopic prolapse
surgery. In general, prolapse and incontinence surgeries
are not combined, but performed consecutively with the
prolapse surgery preceding the tape insertion [16]. Today,
the intra- or paraurethral injection of bulking agents, such
Figure 1. Therapy options for stress urinary incontinence. (A) Stress urinary incontinence: Urine loss while coughing, sneezing or during
physical activities (sports). (B) TVT surgery: In local anesthesia, the tape is inserted vaginally around the urethra and retropubically positi-
oned behind the pubic bone. (C) Colposuspension: The loose approximation of the lateral edges of the vaginal wall to Cooper’s ligament
results in a hammock-like suspension of the urethra to the anterior vaginal wall (according to Burch). (D) Intraurethral injection of the
polyacrylamide hydrogel (PAHG) into the midurethra results in the coaptation of the urethra. (E) Vaginal pessary (RECA fem®): Continence
by pessary insertion. (F) TOT: In local anesthesia, the tape is inserted vaginally around the urethra and positioned by the transobturator
approach along both sides of the pubic bone.
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Mini-Review 3
as Bulkamid®, oers a further treatment alternative to
TVT insertion (Fig.
1-D).
Conservative therapy of stress urinary
incontinence
Guidelines recommend to fully exploiting conservative
measures for the treatment of stress urinary inconti-
nence before considering operative therapies [17]. Con-
servative measures include weight reduction and the lo-
cal application of hormones for epithelial proliferation.
Products with estriol (E3) are preferred over products
with estradiol (E2). Physiotherapy is another important
treatment element. If necessary, it can be used in combi-
nation with electrostimulation, biofeedback or whole
body vibration therapy [18] to strengthen the pelvic oor
muscles and to optimize the muscular coordination. Fur-
thermore, pessaries (ring or bowl shaped, made of sili-
cone, disposable pessaries) are used for urethral support
(Fig. 1-E). They are inserted with the help of an estrogen
cream (E3), and can be changed daily and independently
by the patient.
If all these conservative measures are unsatisfactory, an
operative therapy needs to be considered.
Operative therapy
Tension-free tape insertion
Preoperative investigation
Before deciding for surgery, all conservative treatment op-
tions should be exhausted, the tissue should be well-estro-
genized and built-up and thus, suitable for the operative
intervention. In addition to clinical examination and uro-
dynamics, pelvic oor sonography is very important for
the precise planning of the incontinence surgery. Pelvic
oor sonography enables the assessment of the entire
small pelvis including the anterior, apical and posterior
compartments [19].
Sonographic ndings allow very precise recommen-
dations for surgical indications and the acquisition of op-
erationally important details to plan the intervention.
According to radiological and morphological investiga-
tions by Ulmsten and Petros, the suburethral sling has to
be positioned precisely within the middle third of the
urethra, the key area for achieving continence, between
the point of maximal urethral closure pressure at rest and
the urethral knee which anatomically corresponds to the
attachment site of the ligamenta pubourethralia [11, 20,
21]. Our studies [22 –26] published in recent years showed
that a detailed sonographic diagnosis of the lower uri-
nary tract with special consideration of the physiologi-
cally variable urethral length allowed an exact position-
ing of the sling and thus, optimizes surgical outcome.
Assessments of urethral length and mobility (Fig.
2) and
the height of the paraurethral sulci (Fig.
3) are crucial for
selecting the best suited pathway (retropubic or transob-
turator approach) and the optimal placement of the sub-
urethral sling.
Types of tapes
Incontinence surgeries with tension-free tapes are per-
formed under local anesthesia with analgosedation. There-
by, a macroporous monolament band of polypropylene is
suburethrally inserted. Fibroblasts eventually migrate into
Figure 2.
Preoperative pelvic floor sonography.
(A)
Measurement of the urethral length from bladder neck to the meatus urethrae: 18 mm,
30 mm and 42 mm.
(B)
Urethral mobility at straining: hypomobile, normal mobility, hypermobile.
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4 Mini-Review
the band resulting in a “natural reconstruction” of the tis-
sue. This leads to a new support of the urethra at stress
condition.
The suburethral slings currently available on the market
require dierent insertion and xation techniques. They
can be divided into three groups.
The placement of the classic TVT is retropubic (Fig. 1-B),
while the placement of the TOT is by the transobturator ap-
proach (Fig. 1-F). Both options are equally successful re-
garding cure rates of stress incontinence (80–95 %) [17, 27].
Regarding complications, bladder injuries and emptying
disorders are more frequent with the retropubic method,
while pain (hip/groin/thigh/pubic bone), dyspareunia and
band erosions (Fig. 3) are more frequent with the transob-
turator method. In case of an elevated proximal urethra
and a high, well preserved sulcus vaginalis (nullipara/sta-
tus after preoperations), the classic retropubic tape has a
better outcome than the transobturator tape [17]. In case of
a low position of the urethra and a at sulcus vaginalis
(middle-sized cysto urethrocele/rotatory descent; no pre-
operations) also a transobturator placement (TOT) can be
considered. Furthermore, it has to be taken into account
that retropubic tapes tend to pull towards the proximal, and
transoburator tapes towards the distal direction [26, 28].
The third innovation involves slings with short arms.
With this alternative, the operation procedure should be
less invasive and the risk of injury and pain should be re-
duced. But these so-called “mini slings” are no valuable
alternative to the classic TVT. First, long-term records are
missing and second, initial data suggest a suboptimal sta-
bilization of the tape and lower cure rates [17]. In addition,
the two most commonly used mini slings are no longer
available on the market.
Intraoperative assessments
The incision site should intraoperatively be determined
based on the sonographically measured urethral length
(Fig. 2-A). Ideally, the optimal tape position is at the transi-
tion of the middle to the distal third of the urethra (Fig. 4 -A).
This can be achieved by starting the incision at a distance
from the external urethral orice corresponding to one-
third of the sonographically determined urethral length,
i. e., an urethral length of 45 mm requires an incision at
15 mm distance, and a short urethral length of 18 mm re-
quires an incision starting at 6 mm from the external ure-
thral orice.
Furthermore, the evaluation of the urethral mobility is
important since the tension-free positioning of the tape
also depends on this parameter (Fig.
2-B). For a rotatory
descensus urethrae and a normal and hypermobile ure-
thra, the straightforward intraoperative determination of
the tape-urethra distance with the Cooper scissors is su-
cient to achieve a tension-free position of the tape. How-
ever, for a vertical descensus and a hypo- and immobile
urethra, this procedure can lead to a too large tape-urethra
distance and to only a minimal improvement of the incon-
tinence, or even to therapeutic failure. In these cases, the
intra-operative cough test is very important to adjust the
tape with the low mobility of the urethra.
A correct operative positioning of the tape is more suc-
cessful under physiological anatomical conditions (nor-
mal, non-relaxed tone of the pelvic oor). This requires an
operative procedure in local anesthesia under analgoseda-
tion, as initially described [12]. Prerequisites are: An exact
operative technique (precise setting of local anesthesia), a
careful operation and a well-coordinated timing of opera-
tive steps and anesthesia (sedation/setting of local anes-
thesia/incision and pull through of the tape/cystoscopy/
cough test).
The distance between tape and urethra has a large im-
pact on success and complication rates of the operation
(Fig. 4-B). A large tape-urethra distance of >5 mm is associ-
ated with a lower cure rate. Patients with a too closely posi-
tioned tape, i.e. at <3 mm from the urethra, are signicantly
more often confronted with obstruction complications like
Figure 3. Different positions of TVT and TOT and areas of complications. Axial plane view: position of TVT (left side) and TOT (TVT-O; right
side), with a flat or an elevated sulcus vaginalis, on the left or right side, respectively. Critical areas for complications are circled. Retropu-
bic methods (TVT) have a higher tendency for bladder injuries and voiding dysfunctions, and transobturator methods (TOT) more frequent-
ly result in hip, groin, thigh and pubic bone pain.
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Mini-Review 5
voiding dysfunction and/or de novo urge incontinence.
The tape should be located at the transition site of the
middle to the distal third of the urethra (Fig.
4-A), with an
ideal tape-urethra distance between 3 and 5 mm (Fig.
4-B),
and without urethral kinking.
Recovery time after this operation is short and surgical
scars are minimal. Long-term data show an objective cure
rate of 83 %, and a high subjective satisfaction rate of up to
95 % [23].
Postoperative evaluation and complications after
tape insertion
Frequency and severity of complications after inconti-
nence surgeries [17] depend, inter alia, on the operative
technique (type of tape, following a standardized proce-
dure) and on the experience of the surgeon. Early compli-
cations are bladder perforations, bleedings in the puncture
channel, urinary retention and persistent stress urinary in-
continence. Late complications, which may develop after
years and become increasingly disturbing, are micturition
disorders, urge and pain symptoms, residual urine forma-
tion, recurrent urinary tract infections, irritable bladder
problems, ulcer formation in the area of the tape, dyspare-
unia and also recurrent stress urinary incontinence.
It is important to identify an incorrectly positioned (dys-
topic) tape and to adjust it as soon as possible [25]. The
early postoperative urogynecologic pelvic oor sonography
proves to be essential to detect the so-called “failures” of
the method or to nd the causes for postoperative compli-
cations. Pelvic oor sonography allows a good visualization
of the tape position relative to the urethra (Fig. 4). Further-
more, tape-related, obstructive micturition disorders with
residual urine can easily be detected at an early stage. Post-
operative seromas and hematomas can also be identied.
Therefore, in presence of increased postoperative residual
urine values or symptoms of urge/pain [29], an ultrasound
analysis in sagittal (Fig.
4) and transversal planes should be
performed in the rst postoperative days.
After TVT insertion, voiding dysfunction can be observed
for 5 % of the patients. Very often, this complication is caused
by a dystopic tape position (tape too tight, too close to the
urethra or at the level of the bladder neck). But voiding dys-
function can also be caused by tape distortion, by only a
punctual action of the tape on the urethra, or by kinking of
the urethra.
Tape mobilization and tape incision
Tape mobilization is a simple and successful method to cure
urethral obstruction with disturbed voiding due to a too
tightly positioned or C-shaped tape, without compromising
the outcome of the original stress urinary incontinence sur-
gery [25]. This method is performed by reopening the sub-
urethral incision within the rst days after tape insertion
(Fig. 5) [25, 30]. In cases of an asymmetrically placed tape,
pelvic oor sonography also allows to localize the ideal side
for tape loosening. Tape mobilization usually is not neces-
sary for tape-urethra distances >3 mm, since in most cases,
voiding dysfunctions resolved simultaneously with reduc-
Figure 4. Postoperative pelvic floor sonography. (A) Tape positions relative to the sonographically evaluated urethral length: too proximal,
optimal, or too distal to the bladder neck. The optimal tape position (see dark area in the scheme) is located at the transition of the mi-
durethra to the distal third of the urethral length. (B) Minimal tape-urethra distance: too close (<3 mm), optimal and too far away (>5 mm).
UL: total urethral length; L: urethral length from projected mid-tape position to bladder neck; D: minimal tape-urethra distance; arrows
point to TVT (tension-free vaginal tape); calculation of the relative tape position = L/UL × 100 [%].
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tion of edema, pain and muscle contractions and with re-
sorption of the hematomas. However, smaller tape-urethra
distances (<3 mm) require a tape mobilization. Also here,
the experience of the surgeon plays an important role.
When the tape is only stretched, but not actually mobilized,
it simply returns back into its original position. Converse-
ly,overly aggressive tape loosening increases the risk for
recurrent stress urinary incontinence. Price et al. [31, 32]
identied the benets of tape mobilization immediately af-
ter TVT placement as a resolution of voiding problems and
to avoid long-term catheterization.
Already a few days after tape insertion, broblasts grow
into the polypropylene band. Then, urinary retention can
only be cured by sling incision. However, this procedure
results in a high recurrence rate of stress urinary inconti-
nence of up to 50 % [32]. In cases of voiding dysfunction,
or symptoms of urge and urethral pain, the sling is dissec-
ted suburethrally, a slightly opened clamp is placed below
it and the sling is completely severed with scissors in be-
tween the arms of the clamp. In presence of mesh expo-
sure, the visible part of the sling needs to be resected un-
derneath the healthy skin, suciently distant from the
exposure.
In contrast to tape incision, early tape mobilization rep-
resents a much simpler and more successful method to
treat voiding dysfunction due to a too tightly positioned
tape. Furthermore, tape mobilization can resolve this fre-
quent complication without requiring a second hospitali-
zation and without generating much additional costs. Un-
fortunately, the resolution of simple complications often
starts too late [33] and is nonprofessional (extensive con-
servative therapy instead of surgery, or only incomplete
tape incision). Frequently, this results in tedious, unneces-
sary suering. If stress urinary incontinence persisted af-
ter the rst tape insertion, a second tape can be placed,
provided that the urodynamic assessment shows a func-
tional-operative indication.
Colposuspension
Before the suburethral sling procedures established as the
gold standard, Burch colposuspension in the modication
of Cowan was the standard therapy for stress urinary in-
continence [34]. This method includes the loose approxi-
mation of the lateral edges of the vagina to Cooper's liga-
ment by using non-absorbable sutures (Fig. 1-C). This
results in a hammock-like suspension of the urethra and a
xation of the bladder neck [34, 35]. Cure rates of 70–90 %
are similarly high as for sling insertions [36]. However, the
procedure of colposuspension is much more complex and
invasive, and requires an abdominal open or laparoscopic
surgery with general anesthesia. Therefore, colposuspen-
sion is rarely used in primary therapy, and limited to excep-
tional cases such as the presence of a hypermobile urethra,
or the concomitant prolapse surgery. Postoperative compli-
cations of colposuspension are voiding dysfunction due to
overcorrection, de novo urgency/ urge incontinence symp-
toms, and rectocele and enterocele [37].
Bulking agents
Alternatively, stress urinary incontinence can also be trea-
ted by intra- or paraurethral injection of bulking agents
(Fig. 1-D). Deposits of bulking agents lead to a constriction
(coaptation) of the urethra. Generally, this procedure only
requires a local anesthesia, and hence, represents one of
the least invasive operative therapies of incontinence.
Since the 1970s, a number of bulking materials have
been tested, e. g. teon, autologous fat, bovine or porcine
collagen, silicone particles, dextranomer/hyaluronic acid
copolymer, ethylene vinyl alcohol copolymer, calcium hy-
droxylapatite, polyacrylamide hydrogel and carbon beads
[38, 39]. Most materials have been withdrawn from the
market due to dierent reasons. Currently, there are three
injectable bulking agents approved by the Food and Drug
Administration (FDA) available on the market in the
United States: Durasphere® (carbon-coated beads), Coap-
tite® (calcium hydroxylapatite particles in a gel carrier)
and Macroplastique® (polydimethylsiloxane) [40]. Bulka-
mid®, a polyacrylamide hydrogel (PAHG), is available on
the European market. It is the most frequently used bul-
king agent in Europe, has very good qualities, and data of
se veral years of experience are available [41]. It is sterile,
non-odorous and transparent, and made up of 2.5 % cross-
Key messages
• Primarily, stress urinary incontinence should be trea-
ted by conservative measures.
• Operative options are: suburethral sling insertions
(retropubic or transobturator, mini slings), or the intra-
or paraurethral injection of bulking agents.
• A good build-up of the tissue for surgery, the experi-
ence of the surgeon, the consideration of individual
characteristics, and an effective management of com-
plications all contribute to the success of the inconti-
nence surgery.
• Pelvic floor sonography is crucial for planning, perfor-
ming and evaluation of incontinence surgeries.
Questions
1. Which therapy options are used for the conservative
treatment of stress urinary incontinence? (2 correct
answers)
a) Use of pessaries
b) Anticholinergic agents
c) Local applications of hormones
d) Colposuspension
2. Today, which is the most frequently used surgical me-
thod to treat stress urinary incontinence? (1 correct
answer)
a) Colporrhaphia anterior
b) Suburethral sling insertion
c) Colposuspension
d) Paraurethral injection of bulking agents
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linked polyacrylamide (dry weight) with 97.5 % water.
PAHG is biocompatible, biologically non- degradable, not
absorbable, migration resistant, not toxic and not aller-
genic [39]. Under cystoscopic control, three to four small
submucosal deposits of the PAHG lling substance are
placed transurethrally at the transition of the proximal
urethra to the midurethra. This leads to the support and
the constriction of the urethra.
Bulking agent therapy can be used as primary or second-
ary treatment of stress urinary incontinence. Primary injec-
tion therapy is recommended for patients with complicat-
ing concomitant ndings, such as pronounced obesity,
comorbidities, complications with general anesthesia, vast
varicosis in the small pelvis, and status after radical opera-
tion of cervix or endometrium carcinoma, or after radiation
therapy. Further indications for bulking agent therapy are
requests for a minimally invasive procedure or for a mesh-
free alternative. Secondary injection therapy is suited for
patients after failed previous incontinence surgeries such
as colposuspension or sling insertion [42, 43]. Studies of
bulking agent therapy after failed midurethral sling inser-
tion are rarely described in literature, and can only be
found in a retrospective context [42, 44]. Bulking agent in-
jections oer great advantages for patients with concomi-
tant urge symptoms or with an immobile urethra due to a
preceding surgery (e.g. colposuspension). The method is
easy to perform and has low complication and high cure
rates, particularly in cases of high-risk patients. Risks fac-
tors should individually be evaluated, especially for pa-
tients with recurrent stress urinary incontinence after sling
failure. In presence of the above mentioned risk factors,
bulking agent injection can be oered. It will be interesting
to see the results of a currently ongoing prospective ran-
domized Finnish study that directly compares TVT and
Bulkamid® therapy for the indication of primary stress uri-
nary incontinence. Patient satisfaction, complication rates,
and improvement of continence will be evalua ted(study
number NCT02538991, https://clinicaltrials.gov/).
Conclusions
Suburethral sling insertion represents the current opera-
tive gold standard to treat stress urinary incontinence. A
preoperative sonographic assessment should evaluate the
patient's individual characteristics for the optimal posi-
tioning of the tape. Furthermore, a good postoperative
management of complications will minimize long-term
suering. Postoperative voiding dysfunctions can be cured
by tape mobilization within the rst few days after sling
insertion. In contrast to tape incision, early tape mobiliza-
tion does not impair the chances of cure of the inconti-
nence surgery. Furthermore, intra- or paraurethral injec-
tion of bulking agents is a promising minimally invasive
alternative to treat stress urinary incontinence.
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Manuscript submitted: 25.1.2017
Manuscript accepted: 4.4.2017
Conflict of interest: The authors declare no conflict of interest.
Prof. Dr. med. Volker Viereck
Co-Director, Department of Obstetrics and Gynecology
Head, Urogynecology and Pelvic Floor Disorders
Cantonal Hospital Frauenfeld
Pfaffenholzstrasse 4
Postfach
CH-8501 Frauenfeld
Switzerland
volker.viereck@stgag.ch
www.blasenzentrum-frauenfeld.ch
Answers
1. Answers a) and c) are correct.
Anticholinergic agents are used to conservatively treat urinary urge
incontinence. Colposuspension is an operative and not a conservative
therapy.
2. Answer b) is correct.
TVT insertion or suburethral sling insertion currently is the most fre-
quently used operative therapy to cure stress urinary incontinence.
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