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Is surgery now the primary treatment for stress urinary incontinence in women?
Stress urinary incontinence, defined as the involuntary loss of urine during physical exertion, coughing or sneezing, is a common condition in women and is associated with an impaired quality of life. There are several treatment options, such as pelvic floor muscle training (PFMT) and synthetic midurethral sling (SMUS) operations. Until recently, the sequence of these two modalities (both tested in numerous randomized trials) was clear as, in the absence of direct comparisons, it seemed prudent to put weight on the conservative option as the primary treatment given its almost complete lack of risks. In the light of a newly published head-to-head randomized trial, the evidence for surgery versus physiotherapy as the primary treatment for stress urinary incontinence is reviewed, the data summarized and conclusions drawn for the future management of stress-incontinent women.
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