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Patient-reported outcomes have shown that TOT is not inferior to TVT, but both produce lower success rates than studies using objective measures.

Fifty-six patients with the "urge syndrome" were reviewed between 1 and 5 years after in-patient treatment by bladder training. There was an overall initial cure/improvement rate of 85%. The best long-term results were obtained in those with objectively stable bladders before treatment. Forty-three per cent of patients with reduced detrusor compliance and idiopathic instability relapsed after initial improvement. Those with primary instability or with associated degenerative disease responded poorly to treatment.

Summary. Conventional sling materials have numerous disadvantages. A reinforced Silastic sling is described and its use reported in 30 patients. There was an 83% symptomatic and objective cure of stress incontinence. The advantages of this material include its consistent strength, adjustability and ease of removal.