Stress Urinary Incontinence · Conservative vs Sling

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Type + response to conservative
   Predominantly stress? Has conservative care failed?
   • Stress, conservative not yet adequate → Conservative first (PFMT)
   • Stress, conservative (PFMT ≥3 months) failed → Conservative failed → mid-urethral sling
   • Mixed (significant urge component) → Mixed → treat predominant first
2. [End] Conservative first (PFMT)
   Stress, conservative first: pelvic floor muscle training (PFMT ≥3 months), weight loss, lifestyle ± continence devices/pessary; duloxetine has limited evidence.
3. [End] Conservative failed → mid-urethral sling
   Conservative failed → mid-urethral sling (MUS, retropubic TVT / transobturator TOT, the gold standard); alternatives autologous fascial sling, Burch colposuspension, urethral bulking agents (minimally invasive but less durable, for those unwilling/unsuitable for surgery).
4. [End] Mixed → treat predominant first
   Mixed → treat the predominant component first: urge component → anticholinergic/beta-3 agonist + bladder training; refractory stress component → assess for a sling; counsel fully that urge symptoms may persist after surgery.

Source guidelines & references

• Surgical management of female stress urinary incontinence (AUA/SUFU guideline)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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