From the Guidelines
Midurethral sling is indicated for the treatment of stress urinary incontinence in women, particularly those who experience involuntary leakage of urine during physical activities, such as coughing, sneezing, or exercising, due to weakened pelvic floor muscles or urethral hypermobility 1.
Key Indications
- Women who have failed conservative management, such as pelvic floor exercises
- Those who prefer a minimally invasive surgical option with a quicker recovery time compared to traditional sling procedures
- Synthetic midurethral mesh slings are the most common primary surgical treatment for stress incontinence
Treatment Effectiveness
- Surgical interventions, including midurethral sling, are generally reserved for women whose symptoms do not improve sufficiently with more conservative therapies, but may be the first treatment choice depending on the severity and cause of symptoms 1
- Medications, such as solifenacin and fesoterodine, have been shown to be effective in improving continence, but with a low magnitude of effect 1
Patient Selection
- Women who are obese may benefit from weight loss to improve urinary incontinence symptoms, particularly those with stress versus urge incontinence 1
- Patient preference should be incorporated into the evaluation and treatment of urinary incontinence, with consideration of the effectiveness of different treatments, including pelvic floor muscle training and surgical interventions 1
From the Research
Indications for Midurethral Sling (MUS) Procedure
The indications for a Midurethral Sling (MUS) procedure include:
- Stress urinary incontinence (SUI) due to intrinsic sphincter deficiency and/or urethral hypermobility 2, 3
- Genuine SUI, where the MUS is considered the gold standard for treatment 4
- SUI with or without urethral hypermobility, including mixed incontinence, failed MUS, concomitant prolapse, obesity, and elderly patients 4
Specific Patient Populations
The MUS procedure may be indicated for specific patient populations, including:
- Patients with intrinsic sphincter deficiency 2, 4
- Patients with urethral hypermobility 2, 3
- Patients with mixed incontinence 4
- Patients who have failed previous MUS procedures 4
- Patients with concomitant prolapse 4
- Obese patients 4
- Elderly patients 4
Efficacy and Safety
The efficacy and safety of the MUS procedure have been established in various studies, with low complication rates compared to traditional continence surgeries 3