More than 20 million Americans are estimated to have moderate or severe urinary incontinence. Despite the severe symptoms this common problem causes, many patients fail to seek medical help due to the social stigma associated with the condition; a typical patient will suffer symptoms for more than seven years before seeking help. For the elderly, problems of incontinence often lead to institutional care. It is estimated that more than 200 000 surgical procedures are done each year for the treatment of urinary incontinence.

There are many causes for stress urinary incontinence, and surgery is not always needed to resolve it. For some patients, the symptoms of stress incontinence will resolve with simple non-surgical measures. Current practice guidelines clearly mandate that reversible factors should be identified and treated first. Behavioral treatments are often effective: fluid restriction, diet and bowel management, and pelvic floor exercises. Operative treatment should be reserved for those who have failed these methods, especially pelvic floor muscle strengthening, and who have demonstrable anatomical abnormalities that can only be corrected by surgical procedures.

The current vogue is to construct a compensatory abnormality at surgery – injection of bulking agents, placement of slings, or fixation of tissues to aberrant locations – in an effort to correct incontinence. Surgeons have been swept along by these trends because such procedures are simple and quick to perform in an outpatient setting.