Choosing the right sling for your patient

Abstract

Recent data has demonstrated a one in five lifetime risk of a woman requiring stress urinary incontinence (SUI) surgery. Currently, most women opt for a synthetic midurethral sling (MUS), with over 3.6 million placed worldwide. This article attempts to identify whether a gold standard exists with regards to surgical correction of female SUI. When considering which sling type to use for which incontinent woman, the published data demonstrates excellent results for both synthetic mesh (retropubic or transobturator routes) and fascial pubovaginal slings for most patients. Intrinsic sphincter deficiency does appear to be better treated with the use of a retropubic approach, although still with less than stellar results. With little to differentiate, the treatment of most female SUI may be solely based on which sling the surgeon feels most comfortable performing. Currently, most urologists and gynecologists favour synthetic MUS over fascial slings in surgical-naïve patients; however, recent U.S Food and Drug Administration (FDA) warnings concerning the use of mesh in transvaginal surgery have patients questioning the safety of synthetic MUS for the treatment of SUI.

Conflict of interest statement

Competing interests: Dr. Steele has been an advisor for Allergan and Astellas; a speaker for Abbott and Astellas; has received grants from Astellas and Pfizer; and has participated in clinical trials supported by Astellas and Pfizer. Dr. Bailly has been an advisor and speaker for, has received honoraria from, and has participated in clinical trials supported by Allergan, Astellas, and Pfizer.