Which surgical option tends to have high cure rates for pure stress incontinence in well-selected women?

• A. Midurethral sling (TVT or TOT)
• B. Pubovaginal sling using autologous graft
• C. Bilateral nephrectomy
• D. Urinary diversion

Answer: (A)

For pure stress incontinence in well-selected women, restoring urethral support with a midurethral sling is the approach that tends to yield high cure rates. The sling, placed under the mid-portion of the urethra, acts as a hammock that provides immediate support when abdominal pressure rises (for example, during coughing or sneezing). This backboard helps the urethra stay closed and prevents leakage precisely when stress triggers occur. Because it directly addresses the mechanism of urethral hypermobility or insufficiency with a minimally invasive procedure, many patients experience durable continence with relatively quick recovery and low risk.

Autologous pubovaginal slings can also be effective but require a more invasive operation and graft harvesting, with higher complexity and potential graft-related complications. Bilateral nephrectomy and urinary diversion don’t treat the underlying issue of urethral support and are used for unrelated renal or bladder conditions, so they aren’t appropriate solutions for pure stress incontinence.