MSFinals-1658

A 72-year-old woman has been diagnosed with stress incontinence. Her BMI is 30 kg/m2 and she has a history of hypertension and osteoporosis. She presents to you today with worsening symptoms despite reducing her caffeine intake and starting a regular exercise routine. She has had a normal pelvic exam and has completed three months of pelvic floor exercises with only mild improvement. She is hesitant to undergo surgery due to a previous severe reaction to general anesthesia. What is the next step in managing this patient?