This is a multi-centre randomized controlled trial comparing mid-urethral synthetic mesh sling or tension-free vaginal tape (TVT) and autologous fascia sling (AFS) in elderly patients with stress predominant urinary incontinence. The investigators aim to investigate new onset pelvic pain 6 months post-op and objective urinary incontinence cure rate 5 years post-op. Secondary objectives include investigation of opioid use, mental health, sexual health, and other post-op outcomes.

Inclusion Criteria:

• Adult females at birth (female anatomy, any gender)
• Greater than or equal to 60 years old
• Have stress predominant urinary incontinence (spUI) eligible for both types of surgery (tension-free vaginal tape and autologous fascia sling)
• Exhausted conservative management options for UI (Kegel's exercises, physiotherapy, pessary)
• Completed childbearing
• Able to follow up with clinic visits for up to five years after surgery

Exclusion Criteria:

• Clinical Frailty Score of 6 or more, as moderate frailty is likely associated with excessive postoperative deterioration
• Concurrent pelvic surgery
• Neurogenic bladder
• Previous UI surgery
• Previous pelvic radiation
• Previous mesh exposure
• Presence of pelvic pain for more than three months in the last five years
• Likely unable to follow up
• Immunocompromised individuals receiving immunosuppressive medications for at least 3 months
• Chronic systemic steroid use for at least 3 months for autoimmune diseases
• Unable to stop smoking for at least 3 months prior to surgery and at high risk of restart smoking post-operatively