Stress urinary incontinence (SUI) is common among octogenarian women, often in association with significant comorbidities that can include functional and cognitive impairment. There is limited evidence in the literature on the efficacy and safety of current surgical options for treating SUI in octogenarians. The few studies available on this topic mainly focus on mid-urethral slings and reveal similar efficacy and safety profiles for octogenarian women in comparison to younger women. These studies are mostly retrospective, with small sample sizes and short follow-up. What data there are suggest that greater frailty, not older age, may be associated with complications in the elderly population (>65 yr), a finding that is not specific to octogenarians. Prospective studies with larger sample sizes and longer follow-up are needed to assess the safety and efficacy of the different surgical treatment options for SUI in octogenarians.