Mini-Slings: Unique Issues

Abstract

Single-incision mini-slings (SIMS) are the third generation, minimally invasive alternative to traditional midurethral slings (MUS), like the transobturator (TOT) and retropubic slings (RPS). SIMS are being developed to decrease many risks and complications associated with MUS, including blind trocar entry, postoperative pain, and hematoma formation to name a few. However, akin to MUS, SIMS do not come complication free. No ideal candidate has been identified yet for SIMS procedures. Until then, many of the patient risk factors used to evaluate an MUS candidate may be extrapolated to use in SIMS patients until more data emerges. In recent studies, many perioperative and postoperative complications and issues observed with SIMS are similar to those associated with MUS. Surgeons must be cognizant of intraoperative risks with SIMS, including bladder and vaginal perforation and hematoma formation. Postoperative complications such as failure to treat stress incontinence, recurrences of stress incontinence, de novo urge incontinence, voiding dysfunction, mesh exposure/erosion, and dyspareunia have been observed with SIMS procedures. This chapter serves to discuss the unique issues discovered to date that are associated with SIMS. Due to the paucity of data, there are no long-term studies evaluating the efficacy and safety of SIMS. Continued research is underway evaluating the unique issues presented in this chapter regarding single-incision mini-slings.