Comprehensive management of neurogenic stress urinary incontinence in women

Purpose of review: The management of neurogenic stress urinary incontinence (NSUI) in women presents significant challenges due to the complexity of underlying conditions, the variability in patient responses to treatments, and the limited evidence supporting various therapeutic options. Accurate diagnosis and tailored interventions are crucial, given the coexistence of bladder and bowel dysfunctions and the necessity to consider individual social circumstances. This review aims to update the current strategies for the surgical management of NSUI in women, emphasizing the importance of an individualized, patient-centered approach. Recent findings: The existing scientific literature on NSUI remains limited in both volume and quality, with most studies being retrospective, involving small patient populations and short follow-up periods. These studies often feature heterogeneous groups and varied definitions of success, complicating result interpretation. Promising outcomes have been observed with synthetic midurethral slings and robotic implantation of artificial urinary sphincters (AUS), while autologous fascial slings continue to be regarded as a reliable option. Despite the efficacy of the AUS, device-related complications remain a concern. Other treatments, such as bulking agents and adjustable continence devices, have shown limited success. Summary: A multidisciplinary, patient-tailored approach is essential for managing NSUI in women, aiming to enhance quality of life and protect urinary tract function. Regular follow-up is crucial to monitor and address potential complications, including declining continence rates and other treatment-related adverse events. • Neurogenic stress urinary incontinence in women has significant challenges. • Autologous fascial slings are the preferred surgical method. • Artificial urinary sphincter has high satisfaction rates and functional outcomes. • Adjustable continence therapy (ProACT/ACT) and bulking agents are promising options. • Regular follow-up is paramount to monitor and address potential challenges.