Stress urinary incontinence (SUI) is a common cause of urinary incontinence and negatively affects a woman’s quality of life. One of the surgical options for treatment is a mid-urethral sling (MUS) comprised of monofilament polypropylene. The MUS is the most investigated procedure for SUI and considered to have a relatively low-risk safety profile. However, recent negative publicity and litigation have resulted in the decline of the use of synthetic mesh for prolapse surgery and urinary stress incontinence in recent years. 
The aim of this survey is to investigate whether the current climate has resulted in a change in doctors' and their patients’ preconceptions regarding the use of synthetic mesh for the treatment of SUI.

An electronic survey was distributed among practitioners who provide consultation and treatment for women with SUI, which comprised a total of 16 questions: 10 assessing the patient consultation with SUI (Table 1), and 6 concerning respondents’ demographics. The survey was approved by the IUGA educational committee.

A total of 293 participants completed the survey. Demographics (age, gender, country of practice, title and years of experience) are presented in Table 2. Despite resulting in prolongation of consultation, the majority of respondents (86%) think that patient information leaflet (PIL) should be handed out, and these will provide essential information and better understanding for their patients (73%). However, only 64% of respondents are actually providing the PIL at the time of consultation. Majority of participants would use either IUGA, or their working institute PIL (60%). Only 8% felt that patients have positive preconception of synthetic mesh for SUI.  Interestingly, 83% of respondents haven’t changed their recommendations for the treatment, nor their consent process. The preferred initial surgical treatment for SUI was retropubic MUS followed by transobturator MUS, and then bulking agents. Burch colposuspension and pubovaginal fascial sling were the least preferred treatment initially. According to the survey, clinicians counselling patients presenting with vaginal prolapse and SUI would initially offer vaginal repair with MUS (52%) or vaginal repair alone and MUS later if needed (21%).

Despite the negative publicity and the current medico-legal litigation involving MUS for treatment of SUI, the majority of respondents still prefer this as the initial surgical treatment for SUI. PIL are valued by majority of clinicians, and should be provided in the consultation process for patients with SUI.

Despite the recent negative publicity, the majority of clinicians worldwide, still believe that MUS for treatment of SUI, is considered as the preferred surgical option.