BELIEVE Trial: Bulking vErsus sLing for Treating Stress Urinary IncontinEnce at the Time of Vaginal prolapsE Repair (BELIEVE)

Inclusion Criteria: * Women ≥ 18 years of age. * Have diagnosis of symptomatic or occult stress urinary incontinence (SUI) as noted in their electronic health record (EHR). * Proof of positive testing for SUI via cough stress test (CST) and/or Urodynamic (UDS) testing, * Patients that are planning and eligible for native tissue prolapse repair and for both Retropubic Midurethral Sling (RP-MUS) and Polyacrylamide Hydrogel (PAHG) Exclusion Criteria: * Patients undergoing pelvic organ prolapse repair using mesh or biologic augmentation other than patient's own tissue * Patient anticipating difficulty with completing 24-month follow-up * Anticipation of pregnancy within subsequent 24-months or \<18 months post-partum * Hemoglobin A1c \>10.0% within the past 3-months * Current smoker \> 1 pack per week * History of neurogenic bladder * Current use of any catheterization including but not limited to, intermittent catheterization, indwelling Foley catheter, or suprapubic catheter * Post-void residual \>150 mL felt to not be due to obstruction for prolapse * Prior history of any anti-incontinence procedure including but not limited to any synthetic sling, fascial sling, Burch colposuspension or its variants, and urethral bulking * Previous history of any pelvic radiation * Patient receiving a planned concurrent procedure at the time of prolapse repair.