From the Guidelines
Midurethral Sling (MUS) procedures are indicated for women with stress urinary incontinence who have not responded to conservative therapies.
Indications for MUS
- Stress urinary incontinence: MUS procedures are commonly used to treat stress urinary incontinence, which is the involuntary leakage of urine on effort or exertion, or on sneezing or coughing 1.
- Failed conservative therapies: MUS procedures are typically reserved for women who have not responded to conservative therapies such as weight loss, pelvic floor muscle training, and medications 1.
Evidence for MUS
- Effective treatment: Synthetic midurethral mesh slings, such as MUS procedures, have been shown to be an effective treatment for stress urinary incontinence 1.
- Comparison to other treatments: MUS procedures have been compared to other surgical options, such as urethral bulking agents, retropubic suspension, and fascial slings, and have been found to be a common primary surgical treatment for stress incontinence 1.
Important Considerations
- Patient selection: The decision to undergo a MUS procedure should be made on a case-by-case basis, taking into account the severity and cause of symptoms, as well as patient preferences and medical history 1.
- Potential complications: As with any surgical procedure, MUS procedures carry potential complications, such as direct injury to the lower urinary tract, hemorrhage, infection, bowel injury, or wound complications 1.
From the Research
Indications for Midurethral Sling (MUS) Procedure
The primary indication for a Midurethral Sling (MUS) procedure is:
- Stress Urinary Incontinence (SUI) in women, particularly in cases where conservative treatment has failed 2, 3, 4, 5, 6
Patient Selection
Appropriate patient selection is critical for the success of the MUS procedure. Factors to consider include:
- Patient's overall health and medical history
- Severity of SUI symptoms
- Presence of other urinary or gynecological conditions
- Patient's preferences and expectations 3, 5
Types of MUS Procedures
There are several types of MUS procedures, including:
- Trans-obturator tape (TOT)
- Retropubic sling (TVT, tension vaginal tape)
- Single incision sling (SIS) (Solyx)
- Single incision sling (SIS) (MiniArc) Each type of procedure has its own advantages and disadvantages, and the choice of procedure should be individualized based on patient factors 2, 5
Predictors of Surgical Failure
Identifiable risk factors for surgical failure include:
- Low maximal urethral closure pressure
- Intrinsic sphincter deficiency
- Previous anti-SUI or prolapse surgery
- Presence of neurogenic disease
- Constipation
- Decreased bladder sensation
- Age >65 years
- High pad test
- Diabetes
- Detrusor overactivity
- Post-menopausal status
- Reduced postoperative urethral mobility and tape percentile 2