Hindawi Publishing Corporation Obstetrics and Gynecology International Volume 2012, Article ID 384234, 6 pages doi:10.1155/2012/384234 Review Article Transurethral Radiofrequency Collagen Denaturation for Treatment of Female Stress Urinary Incontinence: A Review of the Literature and Clinical Recommendations James Chivian Lukban Division of Urogynecology, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA 23507, USA Correspondence should be addressed to James Chivian Lukban, lukbanjc@evms.edu Received 1 May 2011; Revised 25 July 2011; Accepted 8 August 2011 Academic Editor: Peter L. Rosenblatt Copyright © 2012 James Chivian Lukban. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Stress urinary incontinence is a prevalent condition in women with a signiﬁcant negative eﬀect on quality of life. Intervention includes behavioral modiﬁcation, intravaginal devices, pelvic ﬂoor muscle exercises, biofeedback, functional electrical stimulation, and surgical procedures. We will review a new in-oﬃce procedure for the treatment of SUI that may serve as a viable nonsurgical option. 1. Introduction Stress urinary incontinence (SUI) is estimated to aﬀect up to 35% of adult women worldwide [1] and 15.7% of community-dwelling women domestically [2]. According to the National Hospital Discharge Survey, there are approx- imately 100,000 inpatient procedures performed for SUI in the United States annually, with outpatient procedures estimated to exceed 105,000 as per the 2006 National Survey of Ambulatory Surgery [3]. The International Continence Society deﬁnes SUI as “the complaint of involuntary leakage of urine upon eﬀort or exertion, or on sneezing or coughing” [4]. In a European sample of 1573 women with urinary incontinence, >80% considered their symptoms to be bothersome, with a negative impact on quality of life as per the Incontinence Quality of Life Questionnaire (I-QOL) [5]. Risk factors for SUI include, but are not limited to, age, parity, history of hysterectomy, forceps delivery, and obesity. Non-surgical treatment options include behavioral mod- iﬁcation, intravaginal devices, pelvic ﬂoor muscle exercises, biofeedback, and functional electrical stimulation. In an assessment of 13 systematic reviews on conservative treat- ment of SUI, Latthe et al. concluded that pelvic ﬂoor muscle training (PFMT) was better than no treatment [6]. Nine-to- twelve-month success rates following PFMT with or without biofeedback and/or health education programs range from 52.6% to 74.8% [7–9]. Long-term durability in these patients is likely a function of life-long exercise. As there is no Food and Drug Administration (FDA) approved medical treatment for SUI, there is a resultant void in terms of invasiveness between conservative therapy and surgical intervention. Urethral bulking agents have shown beneﬁt, however, are indicated for the treatment of SUI due to intrinsic sphincter deﬁciency (ISD), and are not univer- sally administered in an oﬃce setting [10]. Renessa oﬀers an oﬃce-based treatment for SUI in the absence of ISD through radiofrequency energy (RF) delivered transurethrally under local anesthesia. 2. Pathogenesis of SUI The pathogenesis of SUI is thought to be the result of urethral hypermobility secondary to a weakening or disruption of the pelvic ﬂoor musculature and/or pubourethral ligament, with a subsequent loss of pressure transmission from the bladder to the urethra upon provocation [11, 12]. As most women, independent of continence status, exhibit a measure of hypermobility, Blaivas et al. contend that SUI is dependent