Many surgical options exist for women with stress urinary incontinence (SUI).
The traditional gold standards of Burch retropubic colposuspension and pubovaginal slings are still appropriate treatment options for some patients, but randomized controlled trials have demonstrated that synthetic midurethral slings are just as effective as these traditional procedures but with less associated morbidity. Thus, midurethral slings--inserted via a retropubic or transobturator approach--have become the new gold standard first-line surgical treatment for women with uncomplicated SUI. Retropubic midurethral slings are associated with slightly higher success rates than transobturator slings, but at the cost of more postoperative complications. Pubovaginal slings remain an effective option for women with SUI who have failed other procedures, have had mesh complications, or who require concomitant urethral surgery. Single-incision slings have a number of benefits, including decreased operative times and early return to regular activities, but they are yet to be shown to be as effective as midurethral slings. Both retropubic and transobturator midurethral slings are effective for patients with mixed urinary incontinence, but the overall cure rate is lower than for patients with pure SUI. The midurethral sling is suitable for female patients with urethral hypermobility and pure urodynamics-proven SUI, but not for those with urge urinary incontinence or detrusor overactivity, or who have undergone previous surgery.
Cox A, Herschorn S, Lee L. Are you the author?
Division of Urology, University of Toronto, Sunnybrook Health Sciences Centre, Room MG 408, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
Reference: Nat Rev Urol. 2013 Feb;10(2):78-89.