What are the sling treatments for urinary incontinence (UI)?

From the Guidelines

Sling treatments, including midurethral slings, autologous fascial slings, and biological slings, are effective surgical options for urinary incontinence, particularly stress urinary incontinence, with a high success rate of 80-90%. The most common type is the midurethral sling, which involves placing a small strip of synthetic mesh under the urethra to provide support and prevent leakage during physical activities 1. These procedures are typically minimally invasive, performed on an outpatient basis. The two main approaches are retropubic slings (like TVT - Tension-free Vaginal Tape) and transobturator slings (TOT), each with slightly different placement techniques.

Some key points to consider when evaluating sling treatments for urinary incontinence include:

• The choice of intervention should be individualized based upon the patient’s symptoms, the degree of bother the symptoms cause the patient, patient goals and expectations, and the risks and benefits for a given patient 1.
• Autologous fascia pubovaginal sling has been shown to have a success rate of 85% to 92% with 3-15 years of follow-up 1.
• Retropubic midurethral synthetic sling has been extensively studied, with comparative studies showing equivalent effectiveness to the Burch colposuspension 1.
• Potential complications of sling procedures include mesh erosion, pain, infection, or urinary retention, though these are relatively uncommon 1.

In terms of specific recommendations, the use of synthetic sling surgery is contraindicated in stress incontinent patients with a concurrent urethrovaginal fistula, urethral erosion, intraoperative urethral injury and/or urethral diverticulum 1. However, for patients without these contraindications, midurethral sling procedures, such as retropubic slings or transobturator slings, may be offered as a treatment option 1. Ultimately, the decision to use a particular type of sling should be based on the judgment of the surgeon and made in the best interests of the patient.

From the Research

Sling Treatments for Urinary Incontinence (UI)

• Mid-urethral sling procedures (MUS) have been the surgical option of choice for most gynaecologists and urologists treating stress urinary incontinence (SUI) in women around the world for almost 20 years 2.
• The evidence suggests that the long-term effectiveness of the MUS is good and similar to the Burch Colposuspension and the fascial pubovaginal slings 2.
• Mid-urethral sling (MUS) operations are a recognised minimally invasive surgical treatment for SUI, involving the passage of a small strip of tape through either the retropubic or obturator space 3, 4, 5.
• MUS procedures can be performed using either the transobturator route (TOR) or the retropubic route (RPR), with similar subjective cure rates in the short term (up to one year) 4, 5.
• The rate of bladder perforation was lower after TOR (0.6% versus 4.5%) 4, 5.
• Postoperative voiding dysfunction was less frequent following TOR 4, 5.
• Overall rates of groin pain were higher in the TOR group (6.4% versus 1.3%) 4, 5.
• A retropubic bottom-to-top route was more effective than top-to-bottom route for subjective cure 4, 5.
• Urethral slings have high rates of success, but adverse events are more common, including voiding difficulties, postoperative urge incontinence, and urinary tract infections 6.