this study used to compare efficacy between platelet rich plasma periurethral injection versus mid urethral sling ( trans obturator tape ) in treatment of stress urinary incontinence

stress urinary incontinence classified in urodynamic study according to Valsalva leak point pressure to intrinsic sphincteric muscle weakness best treated by PRP periurethral injection and VLPP is less than or equal 60cmH2O and MUCP less than 20cmH2O(21 ) patients enrolled in this group , while hypermobile urethra identified by VLPP is high more than 90cmh2O best treated by trans obturator tape(21) patients recruited in this group , mode of preparation of PRP is by withdrawing 15 ml blood and placed in falcon tube with ACD ( acid citrate dextrose) added centrifuged first at 800 RPM and then the supernatant removed and re-centrifuged again at 3500 RPM and then injected periurethral by 5cc syringe with 30G needle after applying 2% lidocaine ,patient assessed at one and three month objectively by cough stress test and subjectively by ICIQ questionnaire and presence of any adverse effect

Inclusion Criteria:

• stress urinary incontinence identified by urodynamic study
• patient agreement to undergo surgical treatment

Exclusion Criteria:

• previous GUS operation
• evidence of detrusor overactivity urinary system
• presence of pelvic organ prolapse
• malignancies of genitourinary system
• history of hemorrhagic disorders , on anti platelet treatment , uncontrolled diabetes mellitus .

because it depend on female genitourinary system urethral anatomy

in informed consent all participants information will be only known by the research and investigator committee and their personal information will be kept with confidentiality