Selection of midurethral slings for women with stress urinary incontinence

Abstract

Midurethral sling procedures are currently the most commonly performed operations for stress urinary incontinence (SUI), and have proved to be effective and safe. Slings utilizing monofilament polypropylene mesh have the most favorable safety and efficacy results to date. Current data reflect concerns regarding the longterm efficacy of biological slings. Systematic reviews and meta-analyses of randomized controlled trials (RCTs) comparing a retropubic and a transobturator approach have demonstrated equivalence in early to midterm efficacy. The retropubic approach has a greater risk of bladder injury; the transobturator approach is associated with more vaginal perforations and groin pain, though fewer pelvic hematoma. For women with urodynamic stress incontinence (USI) and intrinsic sphincter deficiency (ISD), the transobturator route is less effective than the retropubic approach. Available RCT data are inadequate for definitive conclusions regarding the choice of slings in other important subgroups of patients, including those with recurrent incontinence, those undergoing concomitant prolapse surgery, the elderly, and the obese. The choice of stress incontinence procedure is based on the surgeon's experience as well as clinical grounds. The best results are often achieved with a procedure that works best in the individual surgeon's hands. © 2010 Springer-Verlag Milan.