Traditional suburethral sling operations for urinary incontinence in women

Purpose The midurethral sling (MUS) has largely been regarded as the “gold standard” in treatment of stress urinary incontinence (SUI). Recently the safety and use of the MUS has come under scrutiny following concerns about the use of mesh implants. The aim of this review was to detail the background to SUI which has led to the development of MUS, to highlight the issues surrounding the use of mesh under the current climate of mesh controversies and to provide an update on current evidence on the use of MUS. Materials and methods We conducted a review of the literature looking at the efficacy and safety of MUS. Results MUS has good rates of subjective cure in the short and into the longer term. The overall rates of complications are low including those associated with the use of mesh implants. When compared to other continence procedures, MUS is equally effective in regard to cure but has lower rates of complications and more favorable operative outcomes. The use of mesh has been supported by major Urogynaecological Societies along with the reports from government driven enquiries into the use of mesh. Conclusions Overall, MUS have been shown to be an effective and safe surgical treatment for management of stress urinary incontinence.

Section: Mus Compared To Other Continence Proceduresmentioning

confidence: 99%

Section: Mus Compared To Other Continence Proceduresmentioning

confidence: 99%

Midurethral slings for treatment of stress urinary incontinence review

Ford

Taylor

Ogah

et al. 2019

“…All of the seven randomized or quasi‐randomized trials comparing PVS and colposuspension have been previously reviewed in ICI‐5. The Cochrane Systematic Review was updated in 2017 and no new comparisons between PVS and colposuspension were added . Since ICI‐5, there have been no new comparisons between PVS and MUS and no new comparisons between one type of PVS and another.…”

Section: Traditional Pubovaginal Slings (Pvs)mentioning

confidence: 99%

Surgery for urinary incontinence in women: Report from the 6th international consultation on incontinence

Gomelsky

Athanasiou

Choo

et al. 2018

Urinary incontinence is a prevalent condition worldwide and causes a tremendous impact on a woman's quality of life. While conservative and non‐surgical therapies are options for treatment, surgery for stress urinary incontinence (SUI) is common. Options include colposuspension, slings (pubovaginal and midurethral), and periurethral bulking. While evidence supports each of these options in the treatment of SUI, each is associated with various rates of success and unique adverse event profiles. Urgency urinary incontinence (UUI) is initially treated with behavioral modification and pharmacologic means, with surgery reserved for those with refractory symptoms or significant complications from medication use. At present, intravesical onabotulinumtoxinA injections, percutaneous tibial nerve stimulation, and sacral neurostimulation are all viable options for refractory UUI/overactive bladder. As with surgical interventions for SUI, each of these is, likewise, associated with unique outcomes and adverse event profiles. Herein, we summarize the findings and conclusions from the 6th International Consultation on Incontinence (ICI) regarding surgical treatment of urinary incontinence in women.

“…The controversy about the use of MUS has increased the importance of traditional continence operations such as PVS and BC. Robust evidence for comparison of these procedures is lacking . The only one well‐designed, adequately powered RCT (SISTEr) showed a higher cure rate, a higher risk of voiding dysfunction and a lower risk of POP for the autologous fascial sling (AFS) compared with BC .…”

Section: Methodsmentioning

confidence: 99%

Do we need better information to advise women with stress incontinence on their choice of surgery? Report from the ICI‐RS 2018

Giarenis

Malde

Harding

et al. 2019

Aims:The regulatory warnings about the safety of the synthetic midurethral slings (MUS) had a significant effect on how patients and physicians approach surgical management of stress urinary incontinence (SUI). In this changing landscape, the purpose of this research Think Tank (TT) was to provide an update of the current knowledge about the safety and efficacy of SUI surgery, to review patient goals and expectations and to identify factors affecting the decision making for surgery.Methods: This is a consensus report of the proceedings of TT3: "Do we need better information to advise women with stress incontinence on their choice of surgery?" from the annual International Consultation on Incontinence-Research Society (ICI-RS), June 2018. Results: Despite the body of evidence supporting the continued use of MUS, the short follow-up of most of the studies and the lack of "real life" data regarding pain and sexual dysfunction make the development of recommendations challenging. Women with SUI are often happy to "trade" efficacy for a procedure with less associated morbidity and therefore it is not always the procedure with the highest success rate that is ultimately chosen. However, a number of factors influence treatment decision and there is limited evidence about what level of all these factors women are willing to tolerate for a given success rate, or how much success they are willing to trade for a lower complication rate. Conclusions: The ICI-RS proposed research questions which may be able to assist in improving the counseling and management of women with SUI.