Surgical Innovations for Stress Urinary Incontinence: Insights from Dr. Dinesh Kansal at WALS 2025
 
Stress urinary incontinence (SUI) remains a pervasive condition affecting millions of individuals worldwide, predominantly women, with a significant impact on quality of life. Characterized by the involuntary leakage of urine during physical activities such as coughing, sneezing, or exercising, SUI has long been a target for surgical intervention. At the World Association of Laparoscopic Surgeons (WALS) 2025 conference held on February 24, 2025, Dr. Dinesh Kansal, a renowned gynecologist and pioneer in minimally invasive surgery, shared groundbreaking insights into the latest surgical innovations transforming the management of SUI. With over four decades of experience and training from prestigious institutions like Harvard Medical School, Dr. Kansal’s presentation highlighted the evolution of techniques, the role of laparoscopy, and the future of personalized treatment.
 
The Evolution of SUI Surgery
Historically, treatments for SUI ranged from traditional open procedures like the Burch colposuspension to the introduction of synthetic midurethral slings (MUS) in the late 1990s. While these methods achieved varying degrees of success, they also brought challenges—open surgeries often meant longer recovery times and higher morbidity, while mesh-based slings faced scrutiny due to complications like erosion and chronic pain. Dr. Kansal emphasized that the landscape of SUI surgery has shifted dramatically in recent years, driven by a demand for safer, less invasive, and more durable solutions.
 
At WALS 2025, Dr. Kansal traced this evolution, noting how laparoscopic techniques have redefined the field. “The precision and minimal invasiveness of laparoscopy allow us to achieve outcomes that were once unimaginable,” she remarked. Her presentation underscored how these advancements align with the broader goals of improving patient recovery and reducing complications.
 
Laparoscopic Innovations in SUI Management
Dr. Kansal, who heads the Department of Laparoscopic Gynecological Surgery at BLK-Max Super Specialty Hospital in New Delhi, has performed over 20,000 minimally invasive procedures. At WALS 2025, she showcased the laparoscopic Burch procedure and autologous sling techniques as standout innovations. The laparoscopic Burch colposuspension, a modern adaptation of the classic open surgery, involves suspending the bladder neck to the Cooper’s ligament through small incisions. Using high-resolution video laparoscopy, surgeons can achieve exceptional visibility and precision, minimizing blood loss and tissue trauma.
 
Another highlight was the use of autologous fascial slings, where a patient’s own tissue—typically harvested from the rectus fascia—is used to support the urethra. This approach sidesteps the risks associated with synthetic mesh, offering a safer alternative for patients wary of foreign materials. Dr. Kansal presented data showing that these techniques provide consistent long-term efficacy, particularly for primary and recurrent SUI cases, with lower rates of complications like voiding dysfunction compared to traditional methods.
 
“Laparoscopy isn’t just a tool—it’s a philosophy of care that prioritizes the patient’s well-being,” Dr. Kansal stated. She also discussed the integration of robotic assistance in these procedures, which enhances dexterity and allows for even finer adjustments during surgery. While still emerging, robotic Burch urethropexy and sling placements signal a promising frontier for complex cases.
 
Addressing Contemporary Challenges
The controversy surrounding synthetic mesh has been a pivotal driver of innovation in SUI surgery. Dr. Kansal addressed this head-on, acknowledging the concerns raised by regulatory bodies and patient advocacy groups. She pointed to the resurgence of non-mesh options like autologous slings and colposuspension, which have gained traction as surgeons and patients seek alternatives with proven safety profiles. However, she cautioned that these procedures require a high level of expertise, particularly when performed laparoscopically, underscoring the need for specialized training.
 
Dr. Kansal also explored the role of urethral bulking agents as a less invasive option for select patients. Though not a surgical cure, these injections can bolster urethral resistance with minimal downtime, offering a bridge for those hesitant about more extensive procedures. Her insights reflected a balanced approach—leveraging innovation while respecting patient preferences and clinical realities.
 
The Future of SUI Treatment
Looking ahead, Dr. Kansal envisioned a future where SUI management is increasingly personalized. Advances in imaging and urodynamic testing could soon allow surgeons to tailor interventions to a patient’s specific anatomy and degree of incontinence. She also hinted at the potential of bioengineered tissues and adjustable slings, which could dynamically adapt to a patient’s needs over time, reducing the need for revision surgeries.
 
“Surgery for SUI is no longer a one-size-fits-all solution,” she concluded. “With laparoscopy and emerging technologies, we’re moving toward precision medicine that respects the individuality of each patient.” Her presentation at WALS 2025 not only celebrated current achievements but also set the stage for a new era of innovation in the field.
 
Conclusion
Dr. Dinesh Kansal’s insights at WALS 2025 illuminated the remarkable strides made in surgical approaches to stress urinary incontinence. By championing minimally invasive techniques like laparoscopic colposuspension and autologous slings, she showcased how the field is adapting to meet modern challenges while prioritizing patient outcomes. As a leader in gynecological laparoscopy, her work continues to inspire surgeons worldwide, offering hope to those grappling with SUI and reinforcing the transformative power of innovation in medicine.