From the Guidelines
Midurethral sling placement is a recommended treatment for stress urinary incontinence in women, with success rates of 80-90%, as supported by the most recent guideline update from 2023 1.
Overview of Midurethral Sling Placement
Midurethral sling placement is a minimally invasive surgical procedure used to treat stress urinary incontinence in women by supporting the urethra with a synthetic mesh tape. The procedure involves placing a narrow strip of polypropylene mesh beneath the mid-portion of the urethra through small vaginal and abdominal incisions.
Surgical Approaches
There are two main approaches: retropubic (TVT), where the sling passes behind the pubic bone, and transobturator (TOT), where the sling passes through the obturator foramen.
Procedure and Recovery
The procedure typically takes 30-45 minutes under local, regional, or general anesthesia, often as outpatient surgery. Patients can expect success rates of 80-90% for treating stress incontinence. Recovery involves 2-4 weeks of restricted activity with no heavy lifting (over 10 pounds), avoiding sexual intercourse for 4-6 weeks, and possible temporary self-catheterization if urinary retention occurs.
Potential Complications
Potential complications include mesh erosion (1-5%), urinary retention (5-10%), infection, pain, and bleeding. The sling works by providing support to the urethra during increases in abdominal pressure (like coughing or sneezing), preventing involuntary urine leakage by creating a backboard against which the urethra can be compressed.
Counseling and Patient Education
Prior to selecting synthetic midurethral sling procedures for the surgical treatment of stress urinary incontinence in women, physicians must discuss the specific risks and benefits of mesh as well as the alternatives to a mesh sling, as emphasized in the 2023 guideline update 1.
Key Considerations
The choice of procedure should be made as a collaborative effort between the surgeon and patient, considering patient preferences as well as surgeon experience and judgment, as stated in the 2010 guideline update 1.
Recent Guidelines
The most recent guidelines from 2023 1 and 2017 1 provide updated recommendations and considerations for the surgical treatment of female stress urinary incontinence, including midurethral sling placement.
Conclusion Not Applicable
As per the provided instructions, the focus is on providing a direct and evidence-based answer without a conclusion section. The recommendation for midurethral sling placement is based on the most recent and highest quality evidence available, prioritizing morbidity, mortality, and quality of life outcomes 1.
From the Research
Overview of Midurethral Sling Placement
- Midurethral sling (MUS) procedures are the most common treatment modality for women with stress urinary incontinence (SUI) 2, 3, 4.
- The MUS procedure has been the surgical option of choice for most gynaecologists and urologists treating SUI in women around the world for almost 20 years 4.
- Retropubic and transobturator midurethral sling procedures are safe and effective treatments for stress urinary incontinence but have different complication profiles 3.
Effectiveness and Outcomes
- The long-term effectiveness of the MUS is good and similar to the Burch Colposuspension and the fascial pubovaginal slings 4.
- Repeat MUS for prior MUS failure has shown relatively good success rates, ranging from 55 to 90%, with better outcomes obtained using the retropubic rather than the transobturator route 2.
- Sling plication is an effective and minimally invasive option to treat persistent stress urinary incontinence after failed midurethral sling procedures 5.
Treatment Options for Persistent or Recurrent SUI
- Treatment options for persistent or recurrent SUI after midurethral sling placement include placement of a second midurethral sling, autologous fascial sling, retropubic urethropexy, or urethral bulking 5.
- Shortening of the sling by plication has also been suggested as an alternative option which may reduce operative time, cost, risk of trocar injury, and mesh burden 5.
- Less invasive techniques, such as tape shortening and periurethral injection of a bulking agent, may also be successfully used to manage persistent or recurrent SUI 2.