Tape positioning

Abstract

According to current concepts, appropriate support of the urethra is crucial for female urinary continence. Reinforcement of suburethral structures by implantation of a non-absorbable tape under the midurethra is nowadays a first-choice treatment for stress urinary incontinence in women. The main mechanism of retropubic sling action relies on the angulation of the urethra on a fulcrum created by the tape. In the case of a transobturator sling, the urethral angulation occurs in only 24-50% of cured patients and continence is restored mainly as a result of urethral encroachment by the tape. Placement of the tape under the midurethra is associated with the best cure rate. However, a subset of patients may be also cured even if the tape is located outside this zone. Inappropriate positioning of the tape may increase the risk of postoperative complications. Development of voiding dysfunction or de novo urgency is more common if the tape is placed too tightly. Among several currently available techniques for tape placement, procedures utilizing a retropubic or transobturator approach are the most widely used. Regardless of the approach, tape location around the midurethra, creation of an adequate angle between the tape arms, and tension-free placement seem to be crucial for successful treatment outcome. © 2010 Springer-Verlag Milan.