What are alternatives to the midurethral sling for stress incontinence?

• A. Kidney transplant.
• B. Uroflowmetry only.
• C. Transobturator tape (TOT), retropubic or pubovaginal slings, and bulking injections around the urethra.
• D. Dietary vitamin supplements.

Answer: (C)

The question is about other ways to treat stress urinary incontinence besides the standard midurethral sling. The best alternatives include different urethral-support procedures and periurethral bulking. Transobturator tape is a sling placed via the transobturator route to support the urethra, offering similar effectiveness to other slings but through a different path. A retropubic sling (the classic TVT) sits behind the pubic bone to provide support, while a pubovaginal sling uses tissue, such as autologous fascia, to create a supportive sling anchored to vaginal tissues. Bulking injections involve injecting material around the urethra to improve urethral closure and reduce leakage, which can be suitable for patients who are not good surgical candidates or who have specific contraindications to slings. The listed non-surgical options aren’t treatments for stress incontinence, so they don’t address the underlying issue.