Name an alternative surgical option for stress urinary incontinence when a midurethral sling is unsuitable or has failed.

• A. Bilateral ureteral stenting.
• B. Burch colposuspension or pubovaginal sling using autologous tissue.
• C. Urinary catheterization.
• D. Oral antimuscarinic therapy.

Answer: (B)

When a midurethral sling isn’t possible or has failed, the aim is to restore urethral support so the bladder neck and urethra stop leaking with a rise in abdominal pressure. The best alternative is a procedure that re-establishes this support using tissue-based methods. Burch colposuspension or a pubovaginal sling using autologous tissue accomplish this by elevating and stabilizing the urethra.

In a Burch colposuspension, the urethrovesical junction is lifted and secured to the pelvic sidewall (Cooper’s ligament), which increases the urethral support and improves continence during coughing or sneezing. A pubovaginal sling uses the patient’s own tissue, typically fascia, to create a suburethral sling that provides durable support beneath the urethra.

These approaches are chosen when a midurethral sling isn’t suitable or has failed because they directly reinforce the urethral support mechanism, offering a durable alternative. By contrast, bilateral ureteral stenting addresses obstruction, urinary catheterization is a temporary management, and oral antimuscarinic therapy targets overactive bladder symptoms rather than genuine stress incontinence.