Urinary Incontinence: Minimally Invasive Techniques and Evidence-Based Results
Mid-urethral slings (MUS) have become the cornerstone in the treatment of women with stress urinary incontinence (SUI). This minimally invasive approach has been widely adopted by gynecologists and urologists and has achieved standard of care status. As the surgical technique has been standardized, patient selection for each type of sling type is critical to optimizing success and minimize complications. Transobturator (TO) slings are most useful for mild to moderate severity SUI, while retropubic (RP) slings are indicated for greater severity of SUI (intrinsic sphincteric deficiency). Complications are relatively minor with TO slings (groin pain) but can be more severe with RP slings where the needle passage tract is rather blind. Newer single-incision approaches have become popular but have not reached widespread acceptance.
Recent anti-mesh legal action in the United States has expanded from prolapse to anti-SUI mesh usage. Long-term data on safety and effectiveness of the MUS strongly supports the widespread use of this technique.
KeywordsStress urinary incontinence Continence mechanism Mid-urethral slings Retropubic slings Tension-free vaginal tape Transobturator tape Mini-slings Intrinsic sphincter deficiency
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