Concomitant management of occult and symptomatic stress urinary incontinence

Managing stress urinary incontinence (SUI) is an important, yet challenging, aspect of robotic pelvic floor reconstruction. While many women with pelvic organ prolapse (POP) have coexisting symptomatic SUI preoperatively, women without preoperative SUI may experience de novo SUI following prolapse repair. Therefore, surgeons must consider concomitantly treating symptomatic SUI at the time of prolapse repair as well as prophylactically treating occult SUI to mitigate the risk of experiencing de novo SUI. Midurethral sling placement and robotic Burch colposuspension are two minimally invasive procedures that can successfully treat SUI at the time of robotic pelvic floor repair; however, they pose additional and potentially unnecessary risks. Thus, surgeons are faced with the dilemma of deciding whether or not to perform a concomitant anti-incontinence procedure at the time of robotic pelvic floor repair. Fortunately, pivotal trials have been conducted to aid surgeons in their management choices. This chapter discusses the concomitant treatment of SUI, both symptomatic and occult, at the time of robotic pelvic floor reconstruction.