Recent Developments in the Surgical Management of Urinary Stress Incontinence

Abstract

Surgical management continues to be the mainstay of treatment for patients with moderate to severe stress urinary incontinence who are nonresponsive to conservative measurements. In the past, the Burch colposuspension was considered the first line of treatment; however, since the introduction of mid-urethral slings in the mid 1990s the retropubic sling has become the "gold standard." Tension-free vaginal tape (TVT) is the original retropubic procedure with good long-term efficacy and safety data available. However, in an attempt to decrease the risk of retropubic complications, such as vascular, bowel, or bladder injury, the transobturator and single incision minislings have been described. In this review, we give an overview on the recent data available on conventional anti-incontinence procedures as well as other more recently developed procedures. Recent studies with more than 10 years of follow-up continue to confirm the effectiveness of the TVT sling in the long-term, which the other approaches need to match.

The efficacy and safety comparison of surgical treatments for stress urinary incontinence: A network meta‐analysis

“…After the Kelly procedure was firstly introduced in 1913, various types of surgeries for SUI have emerged and evolved over the decades . Until now, a series of procedures including tension‐free vaginal tape (TVT), transobturator tape (TOT), tension‐free vaginal tape‐obturator (TVT‐O), tension‐free vaginal tape SECUR (TVT‐S), and the adjustable single‐incision sling (Ajust) have been used to treat SUI.…”