Urinary incontinence in women: non pharmacologic approaches and newer pharmacotherapies. An update.

Urinary incontinence is a widespread problem for women, with stress urinary incontinence (SUI) being the most common type. An updated review of PubMed literature using the following keywords was performed: "stress urinary incontinence", "women", "midurethral slings", "bulking agents", "pubovaginal slings", "retropubic suspension", "postoperative complications", and "treatment outcome". More recent publications, systematic reviews, and meta-analyses were given preference. The aging population will increase the demand for care of women with SUI. Patient evaluation should include a careful history of present illness, physical examination, and a discussion about their quality of life and goals of care. Behavioral modifications are considered first line therapy. For surgical treatment, bulking agents are a minimally invasive option with adequate short term cure rates. Both midurethral slings and pubovaginal slings have reported high rates of short and long term success and patient satisfaction. Retropubic suspension and artificial urinary sphincter are also treatment options in appropriately selected patients. The ultimate treatment decision will rely on an informed conversation between the physician and patient.