Editing AUA: Female SUI (2023) (section)

===== Risks of surgical intervention =====
* '''<span style="color:#ff0000">Intra-operative risks: risks of anesthesia, bleeding, UTI, bladder injury, and urethral injury, and procedure-specific risks (see below)</span>'''
* '''<span style="color:#ff0000">Post-operative (4):</span>'''
*# '''<span style="color:#ff0000">Voiding dysfunction</span>'''
*#* '''May involve both storage and emptying symptoms'''
*#* '''Risk of de novo or worsening of baseline storage symptoms for patients with MUI or SUI with urinary urgency.'''
*#* '''Management'''
*#** '''Appropriate and effective to initially treat persistent voiding dysfunction conservatively.''' This includes temporary catheter drainage, CIC, timed voiding, double voiding, biofeedback, pelvic floor muscle training, and anticholinergic therapy.
*# '''<span style="color:#ff0000">Obstruction resulting in urinary retention</span>'''
*#* '''Management'''
*#** '''Would require intermittent catheterization, indwelling Foley catheter drainage, and possible sling incision, sling loosening, or urethrolysis if this does not resolve spontaneously'''
*#** '''Midurethral slings'''
*#*** '''Urinary obstruction after MUS surgery is usually transient and can be managed with short-term intermittent catheterization''', although occasionally symptoms mandate sling release.
*#*** '''If persistently elevated residual urine and bothersome symptoms refractory to conservative management, transvaginal sling release can be attempted'''
*#****'''Transvaginal sling release procedures consistently provide resolution of symptoms with maintenance of continence in the majority of patients.''' 
*#****'''A waiting period of at least 2 to 4 weeks is recommended before sling release.'''
*#**'''Pubovaginal slings'''
*#*** '''Transient urinary retention is common, usually improves or resolves with time'''
*#****'''Most patients return to spontaneous voiding within the first 10 days'''
*#*** '''If persistently elevated residual urine and bothersome symptoms refractory to conservative management and within first 6 weeks after autologous PVS surgery, sling loosening in the operating room''' '''can be attempted.''' 
*#****This is done by first inserting a cystoscope into the bladder (using spinal or general anesthesia) and then gently applying caudal pressure to the urethra. 
*#****'''This procedure is not advised with synthetic slings'''
*#*** '''After 6 weeks or when conservative measures fail, a formal urethrolysis or sling incision is indicated.'''
*# '''<span style="color:#ff0000">Pain with sexual activity</span>'''
*# '''<span style="color:#ff0000">Persistent SUI</span>''' immediately after the procedure or recurrent SUI at a later time that may require further intervention