Studies over 12 years have demonstrated its success. He notes that serious complications are rare and that these are noninvasive procedures, performed with IV sedation and local anesthesia.
Dr. Kathleen Kobashi advocated for the TOT or transobturator sling, which is a safe alternative to retropubic MUS. By avoiding the RP passage, this type of sling minimizes the risks generally associated with this approach. She also noted that this approach appears to be well tolerated in patients who may have some degree of urinary urgency. Currently long term data is lacking but early immediate follow-up suggests that this is going to be the standard sling by 2015.
Dr. Michael Kennelly gave a history of the MUS and reviewed various technique modifications that have been developed to improve safety and minimize invasiveness. He noted that the “mini sling” is the sling of 2015. It was first designed to be placed either in the retropubic or transobturator pathway. Early results have been mixed but promising that these mini slings can provide successful midurethral support with less dissection, less operative time and less intended morbidity of leg muscle obturator nerve adverse events.
Finally, he provided a history of the different midurethral slings that have been released over the past several years (see table):
[refs: Fong ED, Nitti VW. Review article: Mid-urethral synthetic slings for female stress urinary incontinence. BJU Int. 2010 Sep;106(5):596-608
Kennelly MJ, Moore R, Nguyen JN, Lukban JC, Siegel S. Prospective evaluation of a single incision sling for stress urinary incontinence. J Urol. 2010 Aug;184(2):604-9
Kleeman SD, Karram MM. The tension-free vaginal tape procedure. Urol Clin North Am. 2011 Feb;38(1):39-45
McAchran SE. Retropubic versus transobturator midurethral synthetic slings: does one sling fit all? Curr Urol Rep. 2010 Sep;11(5):315-22.
Pickens RB, Klein FA, Mobley JD 3rd, White WM. Single incision mid-urethral sling for treatment of female stress urinary incontinence. Urology. 2011 Feb;77(2):321-4
Richter,, H.E., Albo, M.E., Zyczynski, H.M., Kenton, K., Norton, P.A., Sirls, L.T., Kraus, S.R., Urinary Incontinence Treatment Network. Retropubic versus transobturator midurethral slings for stress incontinence. New England Journal of Medicine. 2010;362(22):2066-76.]
Debate participants: Howard Goldman, Kathleen Kobashi, and Michael Kennelly
Moderated by E. Ann Gormley at the Society for Urodynamics and Female Urology (SUFU) 2011 Winter Meeting - March 1 - 5, 2011 - Arizona Biltmore, Phoenix, Arizona, USA
Reported for UroToday by Diane K. Newman, RNC, MSN, CRNP, FAAN and Continence Nurse Practitioner Specialist - University of Pennsylvania Medical Center.
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