New surgical approaches for urinary incontinence in women.

Urinary incontinence (UI) is highly prevalent and common complaint. A large proportion of women with UI can be correctly diagnosed by their symptoms alone. First line of treatment should follow conservative route in a form of pelvic floor muscle training for stress UI and bladder training for the urgency UI. If conservative management is ineffective, medical and surgical treatment is the next considered. For the treatment of over-active bladder and urgency UI, intra-vesical injections of botulinum toxin A, utilising a flexible or rigid cystoscope has become an established treatment. An alternative to the use of onaBoNTA is sacral nerve stimulation (SNS). Vaginal tapes/slings procedures have become treatment of choice for stress UI. Different approaches of introduction of vaginal tape can be used, including retropubic 'bottom-up' (TVT), and transobturator 'inside-out' (TVT-O), or 'outside-in' (TOT). TVT and TVT-O/TOT seem comparable although there are differences in complications (bladder injury with TVT vs. leg pain with TVT-O/TOT). Recently single incision approaches have been introduced whereby the vaginal tape is inserted via a single vaginal incision. Based on current evidence, single incision slings are not recommended. Individual clinicians should decide which to use based on expertise and experience, nevertheless, bladder injuries are probably less of an issue than leg pain.