Question

What is the best treatment option for genuine stress incontinence?

• A. Burch colposuspension
• B. Kelly's procedure
• C. Sling operation
• D. Tension-free vaginal tape

Hint:

The minimally invasive midurethral synthetic sling is the modern gold standard.

Answer 1

The Correct Option is D

Step 1: Define the condition. Genuine stress incontinence (urodynamic stress incontinence) is the involuntary leakage of urine on effort, exertion, sneezing or coughing, due to urethral hypermobility or sphincter weakness in the absence of detrusor overactivity.
Step 2: Recall the management ladder. Conservative measures (pelvic floor exercises, lifestyle changes) are first line; when surgery is indicated, several procedures exist.
Step 3: Compare the surgical options. Kelly's anterior colporrhaphy/plication has the lowest long-term cure rate and is largely outdated for stress incontinence. Burch colposuspension and pubovaginal sling are effective open procedures. The tension-free vaginal tape (TVT), a midurethral synthetic sling, is the minimally invasive procedure of choice with high cure rates, low morbidity and quick recovery, and has become the gold-standard surgical treatment.
Step 4: Therefore, among the options listed, tension-free vaginal tape is the best treatment for genuine stress incontinence.
Answer: D (Tension-free vaginal tape).