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Female stress urinary incontinence and the mid-urethral sling: Is obstruction necessary to achieve dryness?

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Abstract

Background

Recently, the American Urogynecologic Society and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction released position statements on the use of mid-urethral slings. The statement offers that the polypropylene mesh mid-urethral sling (retropubic and transobturator) is now the recognized worldwide standard of care for the surgical treatment of stress urinary incontinence. The purpose of the current manuscript is to examine whether the polypropylene mesh mid-urethral sling should be the standard of care.

Methods

Data for this review were acquired by a systematic search of the medical literature.

Results

The Trial of Mid-Urethral Slings found that retropubic and transobturator slings were associated with a significant rate of adverse events, despite being comprised of surgeons from high-volume, experienced centers. Stress urinary incontinence is not just a urethral disease due to intrinsic sphincteric deficiency. It can also be related to urethral hypermobility, which in turn is caused by anterior vaginal wall laxity. Often both hypermobility and intrinsic sphincter deficiency coexist. Recognizing the role of anterior vaginal wall support is important to understanding the role of procedures (such as Burch or needle suspension procedures) which have the potential of correcting stress incontinence without affecting voiding parameters.

Conclusions

As a discipline, we need to conceptualize stress incontinence due to urethral hypermobility or intrinsic sphincter deficiency as separate entities and design our procedures to restore the underlying suspected pathology.

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Conflict of interest

The authors declare that they have no conflicts of interest in relation to the content of the manuscript.

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The manuscript is not a clinical study and does not contain patient data.

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Authors and Affiliations

  1. Division of Urology, Albany Medical College, 23 Hackett Boulevard, MC - 208, Albany, NY, 12208, USA

    Amy D. Dobberfuhl & Elise J. B. De

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  1. Amy D. Dobberfuhl
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  2. Elise J. B. De
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Correspondence to Elise J. B. De.

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Dobberfuhl, A.D., De, E.J.B. Female stress urinary incontinence and the mid-urethral sling: Is obstruction necessary to achieve dryness?. World J Urol 33, 1243–1250 (2015). https://doi.org/10.1007/s00345-015-1600-x

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  • DOI: https://doi.org/10.1007/s00345-015-1600-x

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