[Pubo vaginal and sub urethral slings: review]

Abstract

Background: Sling surgery is considered to be the gold standard for treatment of female stress urinary incontinence resulting from sphincter deficiency. A century of experience is reviewed and evolving new concepts and techniques are presented.

Methods: This article reviews 34 retrospective studies involving 2 967 interventions.

Results: and discussion. Sub urethral sling procedures have been reserved traditionally for the treatment of recurrent stress incontinence, autologous or heterologous slings are used and the success rate varies between 65 and 98%. Objective long term results have been excellent but the rate of voiding disorders and de novo detrusor instability is respectively from 12.8% and 16.6%. The TVT procedure (Tension free vaginal tape) was described by U. Ulmsten in 1996. The mesh is placed under the uretra and supports the integral theory of Ulmsten and Papapetros. Its success is bound by its efficacy, its reproducibility and restricted morbidity.

Conclusion: The pubovaginal sling remains an excellent operation for the cure of stress urinary incontinence related both to sphincter deficiency alone or existing with urethral hypermobility. About Prolene tape, the present review of adverse outcomes may simply reflect an overall increase in the number of sling procedures being performed. Although decreased operative time and morbidity have been attributed to the use of TVT tape, it is essential to ensure that long-term safety and efficacy will not be jeopordised before accepting it as a new standard of care.