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Selection of Midurethral Slings for Women with Stress Urinary Incontinence

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Pelvic Floor Disorders

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Abstract

Midurethral sling procedures are currently the most commonly performed operations for stress urinary incontinence (SUI) worldwide and have proved to be effective and safe. Slings utilizing monofilament polypropylene mesh have the most favourable safety and efficacy results to date. 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 haematoma. 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. There is emerging data suggesting some mini-slings could be as effective as transobturator slings. Complications rates are higher in low-volume surgeons. Litigation, poor publicity and medicolegal concerns have led to a decrease in the availability of MUS in many countries and overall a decrease in public confidence in synthetic slings. Women should be given other surgical options such as Burch colposuspension, fascial slings or urethral bulking agents where appropriate. 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, although longer-term data suggests that the bottom-up retropubic midurethral sling is the most effective procedure for urodynamic stress incontinence.

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Author information

Authors and Affiliations

  1. St Vincents Clinic University of NSW, Sydney, NSW, Australia

    Joseph K.-S. Lee

  2. Department of Urogynaecology, Mercy Hospital for Women, Melbourne, VIC, Australia

    Peter L. Dwyer

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  1. Joseph K.-S. Lee
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  2. Peter L. Dwyer
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Correspondence to Joseph K.-S. Lee .

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Editors and Affiliations

  1. Tertiary Referral Pelvic Floor and Incontinence Center, IV°Division of General Surgery, Regional Hospital, Treviso, University of Padua, Padua, Italy

    Giulio A. Santoro

  2. Department of Pediatric Radiology, Medical University of Lublin, Children’s University Hospital, Lublin, Poland

    Andrzej P. Wieczorek

  3. Urogynaecology and Pelvic Floor, Reconstruction Unit, Croydon University Hospital, St George’s University of London, London, UK

    Abdul H. Sultan

1 Electronic Supplementary Material

Advantage Retropubic Sling, Tips on technique by Associate Professor Joseph Lee (MP4 1,113,691 kb)

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Lee, J.KS., Dwyer, P.L. (2021). Selection of Midurethral Slings for Women with Stress Urinary Incontinence. In: Santoro, G.A., Wieczorek, A.P., Sultan, A.H. (eds) Pelvic Floor Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-40862-6_21

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