What would you recommend a woman with moderate stress incontinence, a BMI of 34, no prolapse, and a firm refusal of mesh who wants a surgical procedure with good durability?

The gold standard procedure for patients refusing mesh would be an autologous fascial sling. It would always be reasonable to try a urethral bulking procedure first, as an autologous fascial sling can be a more morbid procedure, but if she is prioritizing durability, the autologous sling is the way ...

The best option would be an autologous fascial sling.