Midurethral slings: which should I choose and what is the evidence for use?

Abstract

Purpose of review: Midurethral slings are currently the most commonly performed surgeries for stress urinary incontinence (SUI). This review examines the pros and cons of the main types of midurethral slings that are available for the surgical treatment of SUI - full-length retropubic, full-length transobturator, and single-incision slings - to assist patients and physicians in choosing between them.

Recent findings: Comparative studies have shown that full-length retropubic and transobturator midurethral slings have similar efficacy but differ in their risk profiles; retropubic slings have higher rates of bladder perforation whereas transobturator slings have more groin pain and dyspareunia. When a certain type of single-incision sling is excluded from systematic reviews, single-incision slings appear comparable to standard midurethral slings.

Summary: Both full-length midurethral slings - retropubic and transobturator - are reasonable for the surgical treatment of SUI. The decision to choose one or the other should be individualized based on patient preference after counseling about the risks of each. More recent data suggest that the currently available single-incision slings may be comparable.