A 43-year-old G2P2 woman is being evaluated for hysterectomy for abnormal uterine bleeding that has not responded to conservative management. She mentions during her evaluation that she has a 2-year history of leaking urine when she coughs, sneezes, or laughs. She does not appreciate a sense of urgency. She has to wear a pad when she leaves the house because of the leaking. She has tried Kegel exercises, but has not had any improvement. A urine culture and post void residual (PVR) are normal. A cough stress test in the office demonstrates leaking urine.
What is the most appropriate surgical procedure to manage this problem?
A. Marshall-Marchetti-Krantz (MMK) procedureA mid-urethral sling is the procedure of choice in women undergoing primary surgery for uncomplicated SUI. For many years, the Burch retropubic colposuspension was considered the gold standard; however, mid-urethral slings have been shown to have comparable success rates, and are less invasive with a shorter operative time and faster recovery. The MMK is a type of bladder neck suspension, and the Stamey is a needle urethropexy; both procedures are no longer used. Anterior repair with Kelly plication is not an effective surgery for treatment of SUI.