A 60-year-old G4P4 woman presents with a two-year history of urine leakage with activity such as coughing, sneezing and lifting. Her past medical history is significant for vaginal deliveries of infants over 9 pounds. She had a previous abdominal hysterectomy and bilateral salpingo-oophorectomy for uterine fibroids. She is on vaginal estrogen for atrophic vaginitis. Physical exam shows no anterior, apical or posterior wall vaginal prolapse. Vagina is well-estrogenized. Post-void residual was normal. Q-tip test showed a straining angle of 60 degrees from the horizontal. Cough stress test showed leakage of urine synchronous with the cough. Cystometrogram revealed the absence of detrusor instability. The patient failed pelvic muscle exercises and was not interested in an incontinence pessary. Which of the following is the best surgical option for this patient?A. Retropubic urethropexyB. Needle suspensionC. Anterior repairD. Urethral bulking procedureE. Colpocleisis

Since it is stated that the woman has a two-year history of urine leakage and had a previous abdominal hysterectomy. These are indications of GSI i.e. Genuine Stress Incontinence, a condition in which increments of intra-abdominal pressure produce involuntary urine loss.

Both urethral hypermobility and Intrinsic Sphincteric Deficiency (ISD) are causes of stress urinary incontinence. Only Retropubic urethropexy is best for patients suffering from GSI due to both hypermobility and Intrinsic Sphincteric Deficiency (ISD). The other options can only address one or none of the specified causes.