Surgical treatment options for stress urinary incontinence include over 200 described procedures in the literature. Those procedures can be broken down into laparoscopic, robotic, abdominal, vaginal and cystoscopic. The abdominal, laparoscopic and robotic surgeries are all variants of a procedure commonly known as a Marshall-Marchetti-Krantz procedure (MMK) or Burch procedure. The vaginal procedures involve various types of slings and needle suspension procedures. Cystoscopic procedures involve urethral bulking agents.
The literature has shown that the "gold standard" procedure for stress urinary incontinence surgery is the Burch procedure. Specifically, the laparoscopic Burch procedure is the procedure of choice for most patients given its unparalleled high success rate (approximately 90% nationwide) and very low complication rate. The same procedure can be done robotically or open, but for most patients we prefer to approach this laparoscopically because it is easier to recover from and the incisions are more cosmetic.
Vaginal procedures such as the sling are also performed, however do to the well publicized high complication and low success rate of the synthetic slings Dr. Margolis exclusively uses organic slings. Slings have an approximately 80% success rate but are still appropriate for older women and those with medical conditions requiring a less invasive surgical approach.
Regarding synthetic vaginal slings and mesh systems, Dr. Margolis has extensive experience treating women with stress urinary incontinence who have suffered complications from these. He has removed now well over 200 sling and mesh implants that have caused serious complications in women.