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Review

Surgical Techniques for Urinary Incontinence in Young Women—Narrative Review

by
Romina-Marina Sima
1,2,
Liana Pleș
1,2,
Oana-Denisa Bălălău
1,2,*,
Mihaela Amza
1,2,
Ileana-Maria Conea
1,2,
Tina-Ioana Bunea
1,2,
Gabriel-Petre Gorecki
3,
Ancuța-Alina Constantin
4,5,
Cristian-Valentin Toma
6,
Mara-Mădălina Mihai
7,8 and
Mircea-Octavian Poenaru
1,2
1
Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
2
“Bucur” Maternity, Saint John Hospital, 012361 Bucharest, Romania
3
Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania
4
Department of Cardio-Thoracic Pathology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
5
Institute of Pneumology “Marius Nasta”, 050159 Bucharest, Romania
6
“Prof. Dr. Theodol Burghele” Clinical Hospital, 061344 Bucharest, Romania
7
Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
8
Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
*
Author to whom correspondence should be addressed.
Surg. Tech. Dev. 2025, 14(3), 28; https://doi.org/10.3390/std14030028
Submission received: 15 April 2025 / Revised: 1 June 2025 / Accepted: 15 August 2025 / Published: 22 August 2025
Versions Notes

Abstract

Urinary incontinence (UI) is a widespread worldwide gynecological pathology with a negative impact on women’s quality of life. We performed a narrative review and present a general, descriptive, and comprehensive perspective about surgical techniques for urinary incontinence in young women. Even though parity and vaginal births represent important risk factors for the occurrence of UI, it is also common among young women who are nulliparous. Lifestyle, obesity, smoking, alcohol consumption, and excessive stretching exercises can contribute to the occurrence of UI. Correct diagnosis and treatment may reduce the negative effects of UI on daily activities. Disease management varies depending on the three types of UI: stress, urge, and mixed. Conservative treatment involves lifestyle changes, pharmacological therapy, and pelvic floor muscle training. If symptoms persist, surgical techniques such as midurethral/suburethral slings, anterior colporrhaphy, and retropubic/laparoscopic colposuspension are necessary. Transvaginal tension-free vaginal tape obturator (TVT-O) is the most common surgical technique for the treatment of UI. Its effectiveness has been proven by reducing symptoms and improving quality of life. Alternative modern treatment methods are vaginal laser therapy, periurethral bulking agents injection, or local injection with autologous platelet-rich plasma. Surgical techniques for the treatment of UI are in continuous development and improvement considering the increased incidence of this pathology and the need of patients to improve symptoms and quality of life.

1. Introduction

Urinary incontinence (UI) is a common but often insufficiently treated problem worldwide. UI represents an involuntary leakage of urine [1,2]. This has negative effects on the patients’ quality of life; it affects self-esteem and can interfere with daily activities [3]. Three types of UI have been described: stress, urge, and mixed. Stress UI is characterized by urine loss when intra-abdominal pressure increases during coughing, laughing, and jumping, and the detrusor muscle does not sufficiently contract in response to this increase. Urge UI is defined by sudden urine loss, by strong micturition urgency, inconsistent with the degree of bladder filling. This is characterized by involuntary contraction of the detrusor with a sensation of urgency. Mixed UI combines symptoms from the two previous types [4].
The etiology of UI is multifactorial and includes damage to the pelvic muscles; bladder dysfunction; and damage to the ligamentous and connective system, nervous structures, or endopelvic fascia, in combination with neuromodulatory changes, which can be both inhibited and facilitated by daily habits [5]. Ostrzenski A. described the hypothesis that site-specific anatomical defects may cause urinary incontinence in women. Ostrzenski A. identified defects in regions not initially thought to be involved in urinary incontinence such as lateral vaginal wall defects, ventral perineal membrane defects, the lateral vaginourethral ligaments, or periurethral and paraurethral defects [6,7].
The prevalence of UI is difficult to assess and depends on the heterogeneity of the study population, the assessment method, and the underreporting of symptoms by patients, ranging between 5% and 70%. Most studies have reported a prevalence between 25% and 45% [8]. UI is approximately two to four times more common in females than males [9]. The prevalence of this condition also varies depending on the type of UI: stress (23.7%), urge (9.9%), or mixed (14.5%). In the fifth decade of life, a peak of stress UI was recorded, while urge or mixed UI became more common with aging [10]. The prevalence of UI in adult women (aged 18 and over) reported in Germany was 48.3% [11] and in Denmark 46.4% [12]. A literature review by Xue et al. that analyzed 48 articles showed that the prevalence of urinary incontinence in China for women under 40 years of age ranged from 2.6 to 30.0%, 8.7 to 47.7% for women aged 41 to 59 years, and 6.9 to 61.6% for women over 60 years of age.
Many risk factors associated with this pathology have been identified, such as age, vaginal birth, constipation, alcohol consumption, smoking, obesity [13], chronic cough, and diabetes [14]. It has been observed that stress urinary incontinence is frequently associated with pelvic organ prolapse, and in many cases it is masked until the prolapse is reduced. Thus, diagnostic methods such as urodynamic evaluations or pessary testing are necessary to identify masked UI [15]. Transperineal ultrasound scanning has proven useful in the evaluation of pelvic floor dysfunction, which has an impact on the choice of treatment method [16]. Ostrzenski A. noted that the POP-Q (Pelvic Organ Prolapse Quantification) system, in its current version, was not suitable for the assessment of female urogenital hiatus and perineal body. The POP-Q system is not suitable for the assessment of stress urinary incontinence [17,18].
We performed a narrative review and present a general, descriptive, and comprehensive perspective about surgical techniques for urinary incontinence in young women.

2. Risk Factors for Urinary Incontinence in Young Women

Despite the known fact that the risk of urinary incontinence increases with aging, gestation, and parity, there are a substantial number of studies on urinary incontinence in young, nulliparous women (Table 1) [19,20]. Stress incontinence tends to predominate among young women, while the proportion of women with urge and mixed incontinence increases with age [8]. Various risk factors for stress incontinence include smoking, age, pregnancy and parturition, obesity, chronic cough, or constipation [21].
Obesity is a well-established risk factor for urinary incontinence at any age [22], and a meta-analysis demonstrated that obesity may be a particularly important and changeable risk factor for urinary incontinence in young women [23]. In women aged 18–36 years, the risk of developing urinary incontinence was almost double in those with a body mass index (BMI) > 30 kg/m2 compared with those with a BMI < 25 kg/m2 [24].
A systematic review published in 2020 reported a prevalence rate of urinary incontinence among sports women of approximately 25.9% in different sports, the most common being stress urinary incontinence [25]. Although physical activity is thought to strengthen the pelvic floor musculature, excessive stretching and overuse may cause the opposite effect [26]. A recent study proposed an association between urinary incontinence and high-impact physical activity due to an increased intra-abdominal pressure that accumulates during high-impact sports to a level that exceeds the intraurethral pressure [27].
Psychological distress is also a contributing factor. High rates of psychological distress have been linked to a high frequency of urinary incontinence in young women [28,29].
Parity is a known risk factor for urinary incontinence, but nulliparous women can also experience the condition. Factors such as constipation, childhood enuresis, and certain toileting behaviors such as delaying urination have been associated with UI in this group [30,31]. A family history and genetic susceptibility to urinary incontinence can also increase the risk [32]. Additionally, lifestyle factors such as alcohol use and smoking have been linked to a higher probability of developing urinary incontinence [33].

3. Treatment for Urinary Incontinence

Treatment of stress urinary incontinence should begin with conservative techniques, such as lifestyle changes, scheduled voiding regimens, physical therapy (pelvic floor muscle training), behavioral therapy, or medication [34]. If these therapeutic methods fail and symptoms persist, surgical methods, such as midurethral sling (retropubic or transobturator), should be considered. Modern treatment methods include single-incision midurethral sling or urethral bulking agents therapies [35]. Treatment options for stress urinary incontinence are presented in Table 2.

4. Conservative Management

First-line treatment for most types of incontinence (stress, urgency, or mixed) includes lifestyle changes and pelvic floor muscle exercise, with bladder exercise for women with urgency incontinence and some women with stress incontinence. If there is evidence of some progress, it is advisable to continue with conservative therapies for up to six months [36,37,38,39].

4.1. Bladder Retraining

Bladder retraining is a conservative treatment for UI and has been shown to improve symptoms in up to 80% of women, although it may be associated with a significant relapse rate in the longer term [40].
A meta-analysis showed that bladder retraining was more effective than placebo and medical therapy [41]. As a result, the International Consultation on Incontinence recommends that bladder retraining should be considered as a first-line treatment for all women with urinary incontinence [42]. Although the evidence for bladder retraining is overall weak, clinical practice supports its use [43,44,45].

4.2. Pelvic Floor Muscle (PFM) Training

Strengthening the PFM has been shown to treat UI in women and is recommended as primary therapy [46]. Exercises to strengthen the PFM include tonic and phasic contraction. Phasic contraction gives immediate support for the urethra, while tonic contraction stabilizes the urethra [47]. In 2020, a study was conducted in which women with stress UI who had never received physiotherapy were divided into those who received PFM training and those who underwent the abdominal hypopressive technique, and researchers showed that PFM training was superior [48]. Training typically consists of regular contraction and relaxation of the perineal muscles, commonly known as Kegel exercises. They are known to improve muscle tone and blood flow [49].

4.3. Biofeedback

Biofeedback is the practice of self-monitoring physiological activities in the body that were previously uncontrolled [50]. Biofeedback as an aid to pelvic floor exercises is particularly useful for women who are unable to isolate the pelvic floor properly or use accessory muscles during perineal contractions.
In particular, biofeedback can help to provide information about the duration and intensity of pelvic floor contractions [51].
This method involves the placement of a vaginal pressure sensor in the vagina, which measures pressure and provides visual or audible feedback on the strength of the perineal contraction. Enhanced versions also use perineal and abdominal electromyography recordings to detect inappropriate contraction of the abdominal and gluteal muscles.
A systematic review and meta-analysis conducted in 2011 found that when compared with women who received pelvic floor muscle exercises alone, those who also underwent biofeedback had higher rates of reporting improvement or resolution of urinary incontinence (RR 0.75, 95% CI 0.66–0.86) [52].

4.4. Pharmacological Therapy

Currently, no pharmacological treatments are officially approved for managing stress incontinence in women, although several medications have been investigated [53]. While various drugs have been used anecdotally in the past, duloxetine—a potent serotonin and norepinephrine reuptake inhibitor—is the only medication specifically licensed for this condition. It enhances urethral sphincter function through a centrally mediated mechanism [54].
Research has demonstrated that duloxetine effectively reduces the frequency of incontinence episodes and improves quality of life [55]. However, nausea is a common side effect, affecting approximately 25% of women. Additionally, duloxetine has been found to work synergistically with pelvic floor muscle (PFM) training [56] and may be beneficial for women considering continence surgery [57].
Systematic reviews of duloxetine for stress urinary incontinence found that treatment was associated with improvements in quality of life, a >50% reduction in incontinence episodes (relative risk [RR] 1.56; 95% CI 1.46–1.66), and global improvement (RR 1.24; 95% CI 1.14–1.36) but were unable to determine whether the results were sustained and noted that one in three patients reported adverse events [58,59].
Alpha-adrenergic agonists, which stimulate urethral smooth muscle contraction, were previously used to treat stress incontinence. They are no longer recommended because they are only slightly more effective than a placebo and have a high rate of adverse effects [60].
There is not enough evidence to support the efficacy of imipramine for stress and mixed incontinence, and adverse effects are considerable [61].

5. Surgical Management

The goal of surgical intervention for UI is to support and lift the urethro-vesical junction. Many surgical techniques have been described, but the choice of treatment method depends on the surgeon’s experience, the patient’s wishes, and co-existing pathologies. The approach can be performed by classical surgical techniques (retropubic urethropexy, anterior colporrhaphy, and midurethral/suburethral slings) or laparoscopically (the approach can be extraperitoneal or intraperitoneal). The most common laparoscopic technique is laparoscopic colposuspension, which can use mesh as an alternative to sutures [62].
In addition to classical surgical techniques, modern treatment methods for UI have also been described: periurethral bulking agents injection [63], vaginal laser therapy [64], or local injection with autologous platelet-rich plasma [65].

5.1. Bulking Agents Injections

Injecting bulking material into the urethral submucosa is a minimally invasive approach for treating stress urinary incontinence. This technique enhances urethral coaptation and resistance, helping to alleviate stress incontinence symptoms. Currently, Bulkamid, Coaptite, Durasphere, and Macroplastique are approved for the treatment of stress UI. The procedure is short, and it does not require general anesthesia and can be performed without stopping anticoagulation therapy [66]. While several bulking materials are available, their effectiveness is often supported by low-quality evidence, and their administration can be technically challenging [67,68]. Urethral bulking therapy is an intervention with minimal risks; approximately one third of patients may experience mild, transient complications and do not require additional interventions [69]. Potential adverse effects can be significant, including allergic reactions, material migration, erosions, fistula formation, sterile abscesses, and infections [70,71]. However, urethral bulking agents are considered safe for the treatment of UI, with a low rate of complications [72].
Periurethral bulking agents injections may represent an effective therapeutic method for young women with stress urinary incontinence who desire pregnancy [63].
In January 2020, a polyacrylamide gel material was approved following a randomized trial comparing it with the midurethral sling. The trial reported a satisfaction rate of 64% for the bulking injection group versus 95% for the sling group, with 16% less complications in the bulking group [73]. A systematic review of over 700 patients found a significant reduction in incontinence episodes and improved quality of life, with a re-injection rate of 24% (ranging from 12% to 35%) [74]. In addition, a seven-year follow-up study of 388 patients showed a cure or improvement in 67% when used as the primary procedure [75].

5.2. Vaginal Laser Therapy

Laser therapy, particularly with Erbium:YAG and CO2 lasers, has gained attention as a minimally invasive treatment for stress urinary incontinence [76]. This procedure is performed on an outpatient basis and typically consists of three to five sessions, spaced about a month apart, with each session lasting 15–30 min [77].
Clinical research has shown notable improvements in both subjective and objective SUI symptoms following laser therapy. For example, fractional CO2 laser treatment has led to significant enhancements in validated assessment tools such as the International Consultation on Incontinence Questionnaire (ICIQ-UI) and the Sandvik severity index [78,79]. Likewise, Erbium:YAG laser therapy has demonstrated substantial benefits in objective evaluations, such as the 1 h pad test, as well as in subjective measures like the ICIQ-UI SF [80]. The best improvement in symptoms after Erbium:YAG laser therapy was observed in women younger than 47.5 years old, ICIQ-UI at a baseline of <10, and a body mass index < 23.3 kg/m2 [81]. In a study that included 73 women with SUI who used Er:YAG laser therapy, it was observed that the reduction in UI symptoms was significantly greater among patients under 39 years old than in those over 60 years old, as well as for patients with a normal body mass index compared with overweight women [82]. Longer-lasting symptom improvement after Erbium:YAG laser therapy has been observed in younger, premenopausal, or early postmenopausal women and especially in those with a normal body mass index [83].
The effectiveness of laser therapy appears to be maintained for up to 1–2 years, with improvement rates exceeding 70% and complete resolution of symptoms in approximately 30% of patients at six months post-treatment [84]. However, if no meaningful progress is observed after the first or second session, alternative treatment options should be considered.
Vaginal laser therapy is a minimally invasive and safe technique for the treatment of urinary incontinence. It has become an alternative to classical surgical techniques because it has few complications. However, chronic pain, vaginal burning, or localized erythema have been reported after laser therapy [85]. Adverse effects are generally minor and short-lasting, including moderate discomfort during the procedure and mild vaginal bleeding in some patients [86]. No significant safety concerns were observed in the studies reviewed. However, it is important to note that in 2018, the FDA warned about the effectiveness and especially the safety of using laser technologies at the vaginal level, such as vaginal “rejuvenation” devices. A caution was issued on the indications for which these techniques are used, especially for aesthetic genitourinary applications. Adverse reactions such as pain, dyspareunia, and burns have been reported [87,88].
In conclusion, laser therapy is a promising, minimally invasive treatment for stress UI, with significant symptom relief with a favorable safety profile.

5.3. Local Injection with Autologous Platelet-Rich Plasma (A-PRP)

The effectiveness of locally injected autologous platelet-rich plasma (A-PRP) for treating stress urinary incontinence in women has been investigated in multiple studies, yielding mixed results.
A pilot study by Long et al. found that A-PRP injections administered to the anterior vaginal wall near the mid-urethra significantly alleviated stress UI symptoms at both 1 and 6 months post-treatment, with no significant adverse effects [89]. Similarly, research by Chiang and Kuo showed that repeated A-PRP injections into the urethral sphincter led to a notable reduction in SUI severity and demonstrated midterm effectiveness, with an overall success rate of 50% and significant improvements in urodynamic parameters [90].
In contrast, a study conducted by Ashton et al. found no statistically significant difference in treatment success between a single PRP injection and saline placebo at 6 months [91]. These findings suggest that while A-PRP may offer potential benefits, the current evidence is inconclusive and highlights the need for larger, well-designed trials to establish its true efficacy.
It was reported that A-PRP treatment for stress urinary incontinence had better results in patients younger than 40 years of age [89]. A study by Chiang et al. reported that age did not influence the improvement of urinary incontinence symptoms after A-PRP therapy [90].
Possible complications associated with autologous platelet-rich plasma therapy are micturition pain, hematuria, difficulty urinating, urinary tract infection, or transient urinary retention [92].

5.4. Midurethral Sling Procedures and Laparoscopic Sling Technique

Surgical treatment options for urinary incontinence in young women primarily focus on stress urinary incontinence, which is the most common type in this demographic. The American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) provide guidelines for these treatments [93].
Retropubic colposuspension represents the traditional procedure, such as the Burch colposuspension, which involves suspending the bladder neck and urethra to the pubic bone. It is less commonly performed today but remains an option, especially for patients undergoing concurrent abdominal surgery [94].
Midurethral sling procedures have become the gold standard in the treatment of UI because the approach is minimally invasive and has low risks of complications, recovery is rapid, and symptom relief is significant [95,96]. The retropubic midurethral sling technique was first described in 1996 and has undergone modifications over time. The transobturator approach was introduced in 2001. The single-incision sling procedure was described in 2006. The short-term efficacy of retropubic and transobturator sling procedures was similar, but a lower recurrence rate was observed at 5 years in the case of the retropubic approach [97]. Transvaginal tension-free vaginal tape obturator (TVT-O) is the most common surgical technique for the treatment of UI, with proven long- and short-term effectiveness [21]. An analysis of 81 studies that included a total of 12,113 participants showed that approximately 80% of women experienced significant improvement in urinary incontinence symptoms up to 5 years after surgery, regardless of the type of approach used [98]. The literature presents conflicting data regarding the effectiveness of single-incision slings. A review that analyzed 31 studies and a total of 3290 patients showed that patients had a higher risk of persistent urinary incontinence symptoms after single-incision slings compared with retropubic or transobturator slings [99]. A randomized trial with 600 participants evaluated the patient-reported success rate after surgery for UI at up to 3 years’ follow-up and concluded that single-incision mini-slings were non-inferior to classic midurethral sling techniques [100]. Schiavi et al. followed for 36 months a total of 159 obese patients undergoing surgery for stress urinary incontinence and compared the results after TVT-O and mini-sling procedures. It was found that the two techniques have the same effectiveness, reducing symptoms and improving quality of life [101]. Single-incision sling and midurethral slings are the most cost-effective options for the treatment of UI [102,103]. In Table 3 we summarized the results of the studies presented above.
The main possible complications after midurethral sling procedures are bleeding and bladder or urethral injury. Significant bleeding was reported in less than 1% of cases and was more common with the retropubic approach. The risk of urethral or bladder injury was approximately 5% with the retropubic approach. The overall risk of complications after midurethral sling procedures was significantly lower with the transobturator approach [104]. Other complications reported were pain, infection, mesh contraction or exposure, dyspareunia, voiding difficulty [105], abnormal vaginal discharge, and significant pelvic pain [106].
Younger women, up to their fifth decade, compared with older women, had fewer complications after the midurethral sling procedure, with persistence or de novo onset of urinary incontinence symptoms increasing with age [107]. The results of another study that compared the effectiveness of the midurethral sling according to patient age indicated that subjective and objective cure rates were higher among younger patients (<64 years), and these parameters showed a decrease with age [108]. Gyhagen et al. reported a cure rate after urethral sling surgery of 88.5% in patients aged 55–64 years and a rate of 64.2% in patients over 75 years. Women with significant health problems had less symptom improvement and lower satisfaction after surgery [109].
Another option is represented by pubovaginal slings. These involve using autologous fascia to create a sling at the urethrovesical junction. They are particularly useful in patients with intrinsic sphincter deficiency or those who prefer to avoid synthetic materials [95,110].
Laparoscopic mesh colposuspension is a therapeutic option for the treatment of urinary incontinence. Higher patient satisfaction and higher subjective and objective cure rates at 1 year after the tension-free vaginal tape procedure were observed than after laparoscopic mesh colposuspension [111]. Laparoscopic colposuspension using sutures compared with laparoscopic colposuspension with mesh and staples showed higher healing rates and a significantly better improvement in patients’ quality of life. Laparoscopic colposuspension with mesh and staples had benefits in terms of operating time and recovery period but had poorer therapeutic results [112].
The failure rate has ranged from 5 to 20% after midurethral sling procedures. There are centers where the laparoscopic two-team sling technique is used for patients with recurrent stress urinary incontinence. This laparoscopic technique involves suturing a suburethral mesh to the Cooper ligaments [113]. Long-term success rates of laparoscopic two-team sling were 91.1%, and few complications were reported. This technique involves inserting mesh vaginally by one team and securing it to the pelvic structures by another team working laparoscopically [114].

6. Postoperative Care and Patient Follow-Up

Postoperative care, physical rehabilitation, and lifestyle changes all come together in the management of stress urinary incontinence after surgery. It varies with the kind of surgery performed, such as midurethral sling, autologous fascial sling, or colposuspension, and with the general health of the patient. The main focus is usually on recovery, maximizing results, and managing complications [115].

6.1. Immediate Postoperative Care

After surgery patients are monitored for a few days in the hospital. The reason is to exclude any complications like bleeding, infection, or urinary retention. Patients may experience mild to moderate pain after surgery. This usually resolves with analgesics like acetaminophen or, if needed, short-term opioids (these are used only for severe pain). Anti-inflammatory drugs (NSAIDs) or applying ice packs to the pelvic area may also help reduce swelling. The wound needs to be properly cleaned and kept dry in order to prevent infection. Usually, for minimally invasive procedures like slings, the incisions heal quickly and should be monitored for infection (redness, discharge, or fever). Mild bleeding or spotting is normal after surgery, but heavy bleeding requires immediate medical attention [116].
After the surgery a catheter is used temporarily to drain urine and to allow bladder rest and healing. It is typically removed within 24–48 h, although this varies depending on the procedure and the surgeon’s preference. After removing the catheter, some patients experience temporary urinary retention, difficulty emptying the bladder fully, or leakage, which usually resolves. Patients are advised to avoid strenuous activity, heavy lifting, or sexual activity for 4–6 weeks, to allow for proper healing. Lifting should be limited to 2 kg. During recovery it is very important to have a proper diet. Adequate hydration is very important to promote healing and reduce constipation, which can strain the pelvic area. Bladder irritants like caffeine, alcohol, or acidic foods should be avoided. A high-fiber diet or stool softeners may be recommended, especially if pain meds cause bowel slowdown. Maintaining a healthy weight reduces pressure on the bladder [117].

6.2. Long-Term Management

It is important that the patients keep the regular follow-up appointments with the surgeon. These are important to follow the healing process and tackle any issues. Follow-up appointments usually take place at 1–2 weeks for healing assessment, then at 6 weeks, then at 3 months, and then at 6 months. The patient can start doing gentle Kegel exercises four to six weeks postoperatively. Kegel exercises will help strengthen the pelvic muscles, which in turn will help with recovery. Guidance and support can be provided by a physical therapist that specializes in pelvic floor rehabilitation [118].

7. Conclusions

Urinary incontinence is a widespread worldwide gynecological pathology, and it is also common among young women. Correct diagnosis and treatment can reduce the negative effects of this pathology on daily activities. Treatment of stress urinary incontinence should begin with conservative management. If this approach fails and symptoms persist, surgical methods should be considered. Bulking agents injections, vaginal laser therapy, and autologous platelet-rich plasma therapy may represent a therapeutic option with significant improvement in symptoms, especially in young women. Transvaginal tension-free vaginal tape obturator is the most common surgical technique for the treatment of urinary incontinence. Surgical techniques are in continuous development and improvement considering the increased incidence of this pathology and the need of patients to improve symptoms and quality of life.

Author Contributions

Conceptualization, R.-M.S. and M.A.; writing—original draft preparation, O.-D.B., C.-V.T., and L.P.; writing—review and editing, R.-M.S. and T.-I.B.; visualization, I.-M.C. and A.-A.C.; supervision, M.-O.P.; project administration, G.-P.G. and M.-M.M. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Data sharing is not applicable to this article.

Conflicts of Interest

The authors declare no conflicts of interest.

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Table 1. Risk factors for urinary incontinence in young women.
Table 1. Risk factors for urinary incontinence in young women.
Age
Smoking
Pregnancy
Parturition
Obesity
Chronic cough
Constipation
Excessive stretching exercises
Alcohol
Table 2. Treatment options for stress urinary incontinence.
Table 2. Treatment options for stress urinary incontinence.
Conservative ManagementSurgical Management
Lifestyle changesMidurethral/suburethral slings
Pharmacological therapyRetropubic colposuspension
Pelvic floor muscle trainingAnterior colporrhaphy
Bladder retrainingLaparoscopic colposuspension
BiofeedbackPeriurethral bulking agent injection
Vaginal laser therapy
Local injection with autologous platelet-rich plasma
Table 3. Surgical treatment for stress urinary incontinence.
Table 3. Surgical treatment for stress urinary incontinence.
StudyType of StudyProceduresResults
Ford et al. [93]Systematic review
81 trials
12,113 women		Retropubic route (RPR) and transobturator route (TOR)
-
RPR had higher morbidity than TOR
-
Bladder perforation, postoperative voiding dysfunction, and suprapubic pain were lower after TOR
-
80% of women experienced significant improvement in urinary incontinence symptoms up to 5 years after surgery
Nambiar et al. [94]Systematic review
31 trials
3290 women		 Mini-sling procedures
-
Higher likelihood of symptoms persisting after single-incision slings than after retropubic or transobturator slings
-
Shorter surgery duration for single-incision slings
-
Higher risk of urge urinary incontinence for single-incision slings
-
Postoperative pain less common for single-incision slings
Abdel-Fattah et al. [95] Non-inferiority randomized controlled trial
600 participants 		Compare standard midurethral slings with single-incision mini-slings
-
Patient-reported similar success rates, quality of life, and sexual function outcomes at 3 years’ follow-up
-
Mesh exposure rates, groin/thigh pain, and dyspareunia rates were higher for single-incision mini-sling
Schiavi et al. [96] Retrospective multicenter study
159 participants 		Compare TVT-O and mini-sling technique
-
Groin pain rates were higher after TVT-O
-
No significant differences in terms of quality of life and sexual function at 36 months’ follow-up
-
Same efficacy in the surgical treatment of SUI
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Sima, R.-M.; Pleș, L.; Bălălău, O.-D.; Amza, M.; Conea, I.-M.; Bunea, T.-I.; Gorecki, G.-P.; Constantin, A.-A.; Toma, C.-V.; Mihai, M.-M.; et al. Surgical Techniques for Urinary Incontinence in Young Women—Narrative Review. Surg. Tech. Dev. 2025, 14, 28. https://doi.org/10.3390/std14030028

AMA Style

Sima R-M, Pleș L, Bălălău O-D, Amza M, Conea I-M, Bunea T-I, Gorecki G-P, Constantin A-A, Toma C-V, Mihai M-M, et al. Surgical Techniques for Urinary Incontinence in Young Women—Narrative Review. Surgical Techniques Development. 2025; 14(3):28. https://doi.org/10.3390/std14030028

Chicago/Turabian Style

Sima, Romina-Marina, Liana Pleș, Oana-Denisa Bălălău, Mihaela Amza, Ileana-Maria Conea, Tina-Ioana Bunea, Gabriel-Petre Gorecki, Ancuța-Alina Constantin, Cristian-Valentin Toma, Mara-Mădălina Mihai, and et al. 2025. "Surgical Techniques for Urinary Incontinence in Young Women—Narrative Review" Surgical Techniques Development 14, no. 3: 28. https://doi.org/10.3390/std14030028

APA Style

Sima, R.-M., Pleș, L., Bălălău, O.-D., Amza, M., Conea, I.-M., Bunea, T.-I., Gorecki, G.-P., Constantin, A.-A., Toma, C.-V., Mihai, M.-M., & Poenaru, M.-O. (2025). Surgical Techniques for Urinary Incontinence in Young Women—Narrative Review. Surgical Techniques Development, 14(3), 28. https://doi.org/10.3390/std14030028

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