Practice bulletin on the management of female stress urinary incontinence in France from the Committee of female urology (CUROPF) of the French Association of Urology (AFU).

Abstract

Female stress urinary incontinence (SUI) is highly prevalent and has a major impact on quality of life. In France, the use of synthetic mid-urethral slings (MUS) has been strongly regulated following the "mesh controversy," creating a transitional period until new national guidelines are published. This practice bulletin, issued by the Committee of Female Urology and Pelviperineology (CUROPF) of the French Association of Urology (AFU), provides interim recommendations for the therapeutic management of female SUI. A patient-centered, shared decision-making process is emphasized, ensuring that women are systematically informed of all available therapeutic options. First-line management includes behavioral measures such as lifestyle modifications, physical activity, and weight loss, which may reduce SUI episodes, especially in overweight and obese women. Pelvic floor muscle training (PFMT), supervised by trained professionals, remains the cornerstone of conservative treatment, with strong evidence supporting its efficacy in both prevention and treatment of SUI. Mechanical devices such as vaginal pessaries may be considered, particularly in association with PFMT, whereas intraurethral occlusive devices are not recommended. Non-pharmacological energy-based treatments (laser, radiofrequency, electromagnetic devices) lack sufficient evidence and should not be used outside clinical trials. Pharmacological management remains limited: duloxetine may provide modest efficacy but is associated with frequent adverse effects, while topical estrogens may improve symptoms in postmenopausal women. MUS surgery continues to be the gold standard in selected cases, with robust long-term efficacy data, but is subject to strict regulations in France, including multidisciplinary evaluation and informed consent.