Trial of Transurethral Bulking Agent Injection Versus Single-Incision Sling for Stress Urinary Incontinence

Inclusion Criteria:

* Women ≥ 21 years
* For \> 3 months, bothersome SUI (response of somewhat, moderately, or quite a bit) without UUI or stress-predominant MUI. For those with equal bother of UUI and SUI, clinician determination that SUI is more severe/significant than UUI is required.
* A positive cough stress test on standardized non-invasive testing or urodynamic SUI within the past 18 months.
* Normal PVR \< 150 mL
* Candidate for either study procedure as determined by treating surgeon
* Available for up to 3 years.
* Agrees to randomization.

Exclusion Criteria:

* Anterior/apical vaginal prolapse beyond the hymen (\>0 on POPQ)
* Urge-predominant mixed UI despite stable therapy
* Advanced UUI/OAB 3rd line therapy treatment within 1 year of enrollment.
* Planned hysterectomy, urethral or anterior/apical surgeries s requiring general anesthesia at the time of SUI treatment, during the last 6 months, or planned within the next 12 months.
* Malignancy or history of radiation of the pelvis
* Pregnant, post-partum, breast feeding or plans for pregnancy within 1 year
* Incomplete emptying (PVR \> 150mL)
* Prior anti-incontinence procedure
* Neurogenic bladder
* Unwilling to continue current UUI treatment until completion of primary outcome at 12 months
* Prior adverse reaction to synthetic mesh or urethral bulking material
* Chronic bladder or pelvic pain conditions (e.g., Interstitial cystitis, painful bladder syndrome, fibromyalgia, chronic pelvic pain, etc.)
* Active treatment for SUI with a pessary. For those using a pessary or other SUI support device, a 3-week washout period should occur prior to assessing baseline measures.