The use of synthetic sub-urethral slings in the treatment of female stress urinary incontinence

Abstract

We set out to review the existing literature regarding the use of synthetic suburethral sling products for the treatment of female stress urinary incontinence. Products currently implanted are examined and scrutinized, and evidence regarding their efficacy and complication rates is noted. Additionally, specifics of presently utilized synthetic materials, including construction method and biocompatibility, are explored and directly correlated to currently marketed products. This investigation was undertaken with the use of the Medline database. Studies pertaining to synthetic or surgical mesh, as well as each specific suburethral sling product, are included. Our findings and ultimately our recommendations stem from the preponderance of evidence supporting the continued use of knitted, macroporous polypropelene mesh slings. Several existing marketed products detailed in the study fit this description. Specific reference is made to recent reports of vaginal erosions and deep space infections related to several specific products. A cautionary note is also made regarding the implantation of transobturator sling products currently marketed without the necessary pre-market testing, potentially placing the public at risk. From the currently available literature on biomaterials, it seems clear that knitted macroporous polypropylene is the material of choice for suburethral implantation. With respect to the means and techniques by which these mesh materials are suburethrally implanted, the surgeon's choice often dictates which method is used, but recent experience has demonstrated that the transobturator approach can be equally as effective as the traditional tension-free vaginal tape, with less-associated morbidity. Ongoing randomized controlled trials will further clarify and distinguish between methods.

Urethral erosion after suburethral synthetic slings: risk factors, diagnosis, and functional outcome after surgical management

“…Obviously, above all, technical error during sling placement is the main causal factor of UE. Regarding our experience and the literature, we suggest seven recommendations to avoid UE when performing a suburethral synthetic sling procedure: (1) Careful dissection of the suburethral plan, (2) good spreading out of the sling and placement under the mid-urethra, (3) absolute respect of the "tension-free" original principle of the TVT technique whatever is the route or the sling material, (4) systematic careful urethrocystoscopy to detect lower urinary tract injury, (5) sling removal and procedure aborting in case of urethral injury recognized during the surgery, (6) avoidance of urethral dilation for the management of late obstructive symptoms. We assume that the suburethral fibrosis is already installed by 7 days after surgery.…”

“…Tension-free vaginal tape (TVT), first described in 1996 by Ulmsten et al [5], has gained general acceptance and has emerged as the most common anti-incontinence procedure worldwide [6]. Its advantages include short operative time, quick postoperative recovery, low complication rate, and good effectiveness [7].…”

Mechanical properties of polypropylene mesh used in pelvic floor repair

“…This observation seems to be supported by other authors. Feifer and Corcos [18] referred that tensile strength of synthetic meshes is not a differentiating factor among products since it is one order of magnitude higher than normal fibrous tissue. Neymeyer et al [19] also recommended that the most appropriate mesh properties should be as close as possible to natural human tissue.…”

Long-term follow-up of intravaginal slingplasty operation for urinary stress incontinence

“…Feifer and Corcos, in a review article on synthetic suburethral slings [10], conclude that products for surgical interventions can be marketed without the benefit of rigorous pre-marketing testing and that randomized blinded studies have not been undertaken for the evaluation of new products. Longitudinal controlled studies are the only way that the surgical and scientific communities can ascertain the durability and success of suburethral slings and the material from which they are comprised.…”