Springer Nature is making Coronavirus research free. View research | View latest news | Sign up for updates

Joint report on the terminology for surgical procedures to treat stress urinary incontinence in women

  • 14 Accesses


Introduction and hypothesis

Standardized terminology for surgical procedures commonly performed to treat stress urinary incontinence in women is needed to facilitate research, clinical care, and teaching in female pelvic medicine and reconstructive surgery.


This report combines the input of members of the American Urogynecologic Society and the International Urogynecological Association, assisted by external referees. Extensive searches of the literature were performed, including Instructions for Use brochures and original source documents where possible. Historical context was considered along with procedural modifications, and expert opinion was included when appropriate.


A terminology report for the procedures commonly performed to treat stress urinary incontinence in women was produced. Included procedures are midurethral sling, retropubic colposuspension, pubovaginal sling, urethral bulking, and artificial urinary sphincter. Appropriate figures have been included to supplement and help clarify the text. Ongoing review will be performed periodically to keep the document updated and widely acceptable.


This document is a literature and consensus-based terminology report for surgical procedures to treat stress urinary incontinence in women. Future publications in female pelvic medicine and reconstructive surgery should use this standardized terminology whenever possible.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig 2
Fig 3
Fig. 4
Fig. 5


  1. 1.

    Artibani W, Novara G. International continence society terminology for the lower urinary tract: the importance of standardization. Nat Clin Pract Urol. 2005;2(12):576–7.

  2. 2.

    Haylen BT, de Ridder D, Freeman RM. Et al; international Urogynecological association; international continence society. An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.

  3. 3.

    Committee opinion: evaluation of uncomplicated stress urinary incontinence in women before surgical treatment. American Urogynecologic Society and American College of Obstetricians and Gynecologists. Female Pelvic Med Reconstr Surg. 2014;20:248–51.

  4. 4.

    Nager CW, Brubaker L, Litman HJ, et al. A randomized trial of urodynamic testing before stress-incontinence surgery. N Engl J Med. 2012;366:1987–97.

  5. 5.

    Petros PE, Ulmsten UI. An integral theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand Suppl. 1990;153:7–31.

  6. 6.

    Wohlrab KJ, Erekson EA, Myers DL. Postoperative erosions of the Mersilene suburethral sling mesh for antiincontinence surgery. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(4):417–20.

  7. 7.

    Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2017;7:Cd006375.

  8. 8.

    Rodriguez LV, Raz S. Prospective analysis of patients treated with a distal urethral polypropylene sling for symptoms of stress urinary incontinence: surgical outcome and satisfaction determined by patient driven questionnaires. J Urol. 2003;170(3):857–63.

  9. 9.

    Amid PK. Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia. 1997;1(1):15–20.

  10. 10.

    Schimpf MO, Rahn DD, Wheeler TL, et al. Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis. Am J Obstet Gynecol. 2014;211(1):71.e1‑e27.

  11. 11.

    Slack M, Sandhu JS, Staskin DR, et al. In vivo comparison of suburethral sling materials. Int Urogynecol J. 2006;17(2):106–10.

  12. 12.

    Tension-free Vaginal Tape (TVT) System [Instructions for use, version 1]. Somerville, NJ: Gynecare, a division of Ethicon, Inc., a Johnson & Johnson Company; 2009. Available at: Accessed 05 November 2018.

  13. 13.

    Ward K, Hilton P; United Kingdom and Ireland Tension-free Vaginal Tape Trial Group. Prospective multicentre randomised trial of tension-free vaginal tape and colposuspension as primary treatment for stress incontinence. BMJ 2002;325(7355):67.

  14. 14.

    Delorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women [in French]. Prog Urol. 2001;11(6):1306–13.

  15. 15.

    de Leval J. Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol. 2003;44(6):724–30.

  16. 16.

    Molden SM, Lucente VR. New minimally invasive slings: TVT Secur. Curr Urol Rep. 2008;9(5):358–61.

  17. 17.

    Ugurlucan FG. Adjustable Midurethral Slings in the Treatment of Female Stress Urinary Incontinence. In: Alhasso A, ed. Synopsis in the Management of Urinary Incontinence. London: IntechOpen; 2017.

  18. 18.

    Richter HE, Litman HJ, Lukacz ES, et al. Demographic and clinical predictors of treatment failure one year after midurethral sling surgery. Obstet Gynecol. 2011;117(4):913–21.

  19. 19.

    Brubaker L, Norton PA, Albo ME, et al; Urinary Incontinence Treatment Network. Adverse events over two years after retropubic or transobturator midurethral sling surgery: findings from the Trial of Midurethral Slings (TOMUS) study. Am J Obstet Gynecol. 2011;205(5):498.e1–6.

  20. 20.

    Urinary incontinence in women. ACOG Practice Bulletin No. 155. American College of Obstetricians and Gynecologists Obstet Gynecol 2015;126(5):e66–81.

  21. 21.

    AUA. Position Statement on the use of vaginal mesh for the surgical treatment of stress urinary incontinence (SUI). Available at: https://www.auanetorg/guidelines/use-of-vaginal-mesh-for-the-surgical-treatment-of-stress-urinary-incontinence2013. Accessed 05 November 2018.

  22. 22.

    Gynecare TVT™ Obturator System [Instructions for Use]. Somerville, NJ: Gynecare, a division of Ethicon, Inc., a Johnson & Johnson Company; 2015.

  23. 23.

    Swati J. Midurethral synthetic sling. In: Swati J, Ferriman E, eds. Medicolegal Issues in Obstetrics and Gynaecology. New York, NY; Springer. 2018:265–68.

  24. 24.

    Miranne JM, Dominguez A, Sokol AI, et al. Balloon catheter guide use during midurethral slings: does it make a difference? Can J Urol. 2015;22(3):7811–6.

  25. 25.

    Muir TW, Tulikangas PK, Fidela Paraiso M, et al. The relationship of tension-free vaginal tape insertion and the vascular anatomy. Obstet Gynecol. 2003;101:933–6.

  26. 26.

    Whiteside JL, Walters MD. Anatomy of the obturator region: relations to a trans-obturator sling. Int Urogynecol J Pelvic Floor Dysfunct. 2004;15(4):223–6.

  27. 27.

    Sokol ER. Rardin C. ObGyn News: Expert tips on retropubic vs. transobturator sling approaches; 2015. Available at: Accessed 05 November 2018.

  28. 28.

    Burch JC. Urethrovaginal fixation to Cooper's ligament for correction of stress incontinence, cystocele, and prolapse. Am J Obstet Gynecol. 1961;81:281–90.

  29. 29.

    Marshall VF, Marchetti AA, Krantz KE. The correction of stress incontinence by simple vesicourethral suspension. Surg Gynecol Obstet. 1949;88(4):509–18.

  30. 30.

    Tanagho EA. Colpocystourethropexy: the way we do it. J Urol. 1976;116(6):751–3.

  31. 31.

    Dean NM, Ellis G, Wilson PD, et al. Laparoscopic colposuspension for urinary incontinence in women. Cochrane Database Sys Rev. 2006;19(3):Cd002239.

  32. 32.

    Ankardal M, Ekerydh A, Crafoord K, et al. A randomised trial comparing open Burch colposuspension using sutures with laparoscopic colposuspension using mesh and staples in women with stress urinary incontinence. BJOG. 2004;111(9):974–81.

  33. 33.

    Cornella JL, Pereyra AJ. Historical vignette of Armand J. Peryra, MD, and the modified Pereyra procedure: the needle suspension for stress incontinence in the female. Int Urogynecol J 1990; (1):25–30.

  34. 34.

    Bodell DM, Leach GE. Needle suspension procedures for female incontinence. Urol Clin North Am. 2002;29(3):575–84.

  35. 35.

    Kobashi KC, Albo ME, Dmochowski RR, et al. Surgical treatment of female stress urinary incontinence: AUA/SUFU guideline. J Urol. 2017;198(4):875–83.

  36. 36.

    Nygaard IE, Heit M. Stress urinary incontinence. Obstet Gynecol. 2004;104(3):607–20.

  37. 37.

    NICE. Guideline NG 123: urinary incontinence and pelvic organ prolapse in women: management. Available at: https://www.niceorguk/guidance/NG123; 2019. Accessed 05 November 2018

  38. 38.

    Te Linde RW, Rock JA, Jones HW. TeLinde's operative Gynecology. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003.

  39. 39.

    Souza RJ, Resende JAD. Júnior, Miglio CG, et al. can reducing the number of stitches compromise the outcome of laparoscopic Burch surgery in the treatment of stress urinary incontinence? Systematic review and meta-analysis. Rev Col Bras Cir. 2017;44(6):649–54.

  40. 40.

    Bidmead J, Cardozo L. Sling techniques in the treatment of genuine stress incontinence. BJOG. 2000;107(2):147–56.

  41. 41.

    Aldridge AH. Transplantation of fascia for relief of urinary stress incontinence. AJOG. 1942;44:398–411.

  42. 42.

    Beck RP, Grove D, Arnusch D, et al. Recurrent urinary stress incontinence treated by the fascia lata sling procedure. Am J Obstet Gynecol. 1974;120(5):613–21.

  43. 43.

    McGuire EJ, Lytton B. Pubovaginal sling procedure for stress incontinence. J Urol. 1978;119(1):82–4.

  44. 44.

    Blaivas JG, Jacobs BZ. Pubovaginal fascial sling for the treatment of complicated stress urinary incontinence. J Urol. 1991;145(6):1214–1218.

  45. 45.

    Cross CA, Cespedes RD, McGuire EJ. Our experience with pubovaginal slings in patients with stress urinary incontinence. J Urol. 1998;159(4):1195–1198.

  46. 46.

    Broussard AP, Reddy TG, Frilot CF, et al. Long-term follow-up of porcine dermis pubovaginal slings. Int Urogynecol J. 2013;24(4):583–7.

  47. 47.

    Fialkow MF, Lentz GM, Miller EA, et al. Complications from transvaginal pubovaginal slings using bone anchor fixation. Urology. 2004;64(6):1127–32.

  48. 48.

    Goldberg RP, Tchetgen MB, Sand PK, et al. Incidence of pubic osteomyelitis after bladder neck suspension using bone anchors. Urology. 2004;63(4):704–8.

  49. 49.

    Rehman H, Bezerra CA, Bruschini H, et al. Traditional suburethral sling operations for urinary incontinence in women. Cochrane Database of Sys Rev. 2017;7:CD001754.

  50. 50.

    Mahdy A, Ghoniem GM. Autologous rectus fascia sling for treatment of stress urinary incontinence in women: a review of the literature. Neurourol Urodyn 2019;38Suppl 4;S51–8.

  51. 51.

    Albo ME, Richter HE, Brubaker L, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med. 2007;356(21):2143–55.

  52. 52.

    Ghoniem GM, Miller CJ. A systematic review and meta-analysis of macroplastique for treating female stress urinary incontinence. Int Urogynecol. 2013;24(1):27–36.

  53. 53.

    Lightner DJ, Itano NB, Sweat SD, et al. Injectable agents: present and future. Curr Urol Rep. 2002;3(5):408–13.

  54. 54.

    Mayer RD, Dmochowski RR, Appell RA, et al. Multicenter prospective randomized 52-week trial of calcium hydroxylapatite versus bovine dermal collagen for treatment of stress urinary incontinence. Urol. 2007;69(5):876–80.

  55. 55.

    Kasi AD, Pergialiotis V, Perrea DN, et al. Polyacrylamide hydrogel (Bulkamid(R)) for stress urinary incontinence in women: a systematic review of the literature. Int Urogynecol J. 2016;27(3):367–75.

  56. 56.

    Lee PE, Kung RC, Drutz HP. Periurethral autologous fat injection as treatment for female stress urinary incontinence: a randomized double-blind controlled trial. J Urol. 2001;165(1):153–8.

  57. 57.

    Hurtado E, McCrery R, Appell R. The safety and efficacy of ethylene vinyl alcohol copolymer as an intra-urethral bulking agent in women with intrinsic urethral deficiency. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(8):869–73.

  58. 58.

    Zoorob D, Karram M. Bulking agents: a urogynecology perspective. Urol Clin North Am. 2012;39(3):273–7.

  59. 59.

    Chaliha C, Williams G. Periurethral injection therapy for the treatment of urinary incontinence. Br J Urol. 1995;76(2):151–5.

  60. 60.

    Sangster P, Morley R. Biomaterials in urinary incontinence and treatment of their complications. Indian J Urol. 2010;26(2):221–9.

  61. 61.

    Kowalczyk JJ, Mulcahy JJ. Use of the artificial urinary sphincter in women. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11(3):176–9.

  62. 62.

    Costa P, Mottet N, Rabut B, et al. The use of an artificial urinary sphincter in women with type III incontinence and a negative Marshall test. J Urol. 2001;165(4):1172–6.

  63. 63.

    Petrou SP, Elliott DS, Barrett DM. Artificial urethral sphincter for incontinence. Urology. 2000;56(3):353–9.

  64. 64.

    Maillet F, Buzelin JM, Bouchot O, et al. Management of artificial urinary sphincter dysfunction. Eur Urol. 2004;46(2):241–5.

  65. 65.

    Phe V, Leon P, Granger B, et al. Stress urinary incontinence in female neurological patients: long-term functional outcomes after artificial urinary sphincter (AMS 800(TM)) implantation. NeurourolUrodyn. 2017;36(3):764–9.

  66. 66.

    Elliott DS, Barrett DM. The artificial urinary sphincter in the female: indications for use, surgical approach and results. Int Urogynecol J Pelvic Floor Dysfunct. 1998;9(6):409–15.

  67. 67.

    Venn SN, Greenwell TJ, Mundy AR. The long-term outcome of artificial urinary sphincters. J Urol. 2000;164:702–6.

  68. 68.

    Costa P, Poinas G, Ben Naoum K, et al. Long-term results of artificial urinary sphincter for women with type III stress urinary incontinence. Eur Urol. 2013;63(4):753–8.

  69. 69.

    Roupret M, Chartier-Kastler E, Almeras C, et al. Sacral neuromodulation for refractory detrusor overactivity in women with an artificial urinary sphincter. J Urol. 2004;172(1):236–9.

  70. 70.

    Richard F, Lefort J, Bitker M, et al. Female incontinence with primary sphincter deficiency: results of artificial urinary sphincter (AMS 800) with long-term follow-up. J Urol. 1996;155:1568.

  71. 71.

    Saffarian A, Walsh K, Walsh IK, et al. Urethral atrophy after artificial urinary sphincter placement: is cuff downsizing effective? J Urol. 2003;169(2):567–9.

  72. 72.

    Roupret M, Misrai V, Vaessen C, et al. Laparoscopic approach for artificial urinary sphincter implantation in women with intrinsic sphincter deficiency incontinence: a single-Centre preliminary experience. Eur Urol. 2010;57(3):499–504.

  73. 73.

    Biardeau X, Rizk J, Marcelli F, et al. Robot-assisted laparoscopic approach for artificial urinary sphincter implantation in 11 women with urinary stress incontinence: surgical technique and initial experience. Eur Urol. 2015;67(5):937–42.

  74. 74.

    Peyronnet B, Vincendeau S, Tondut L, et al. Artificial urinary sphincter implantation in women with stress urinary incontinence: preliminary comparison of robot-assisted and open approaches. Int Urogynecol J. 2016;27(3):475–81.

  75. 75.

    Morgan K, Milner HR, Tikekar A, et al. Long term use of hydraulic artificial urethral sphincters in nine dogs from New Zealand with urethral sphincter mechanism incompetence. N Z Vet J. 2018;66(4):205–9.

Download references


The following are being recognized for their contributions to this article: Sarah A. Collins, MD, (Northwestern University, Feinberg School of Medicine, Chicago, IL); Steven Swift, MD, (Medical University of South Carolina, Charlston, SC); Swati Jha, MD, (JessopWing, Sheffield Teaching Hospitals NHSFT, Sheffield, UK); Anna Rosamilia, MD (Monash University Department of Obstetrics and Gynecology, Monash Medical Center, Melbourne, Australia); Renaud de Tayrac, MD (Service de Gynécologie-Obstétrique, CHU Carémeau,Nîmes Cedex 9, France).

Author information

Ethics declarations

Conflicts of interest

S.A.C. is an expert witness from Ethicon / Johnson & Johnson and an expert reviewer for medical guidelines clearinghouse. S.S. is a legal expert for Boston Scientific and a researcher local PI for Cook Myosite. A.R. is an Ethicon expert witness Boston scientific - investigator led sponsored research grant. R.D.T. is a consultant for Boston Scientific and Coloplast. The contributors have declared they have no conflicts of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Individual contributors are noted in the Acknowledgments section.

This report is being published concurrently in Female Pelvic Medicine and Reconstructive Surgery and in International Urogynecology Journal. The report is identical except for minor stylistic and spelling differences in keeping with each journal’s style. Citations from any of the two journals can be used when citing this article.

Correspondence: Sarah A. Collins, MD, Northwestern Medical Group, 250 E. Superior St, Ste. 5-2370, Chicago, IL 60611, USA.


Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Valderrama, V., Collins, S.A., Swift, S. et al. Joint report on the terminology for surgical procedures to treat stress urinary incontinence in women. Int Urogynecol J (2020).

Download citation


  • Stress urinary incontinence
  • Midurethral sling
  • Retropubic colposuspension
  • Pubovaginal sling
  • Urethral bulking
  • Artificial urinary sphincter