[Guidelines for the surgical treatment of female urinary stress incontinence in women using the suburethral sling]

Abstract

Today, placement of a suburethral sling is the reference technique for cure of female stress incontinence. Use of slings made exclusively of knitted polypropylene monofilament is recommended to the exclusion of all other materials. The NF indication is a guarantee that preclinical studies have been conducted before market authorization. Although biocompatible, the material remains synthetic, and this biocompatibility should not obviate the need for respecting the principles of asepsis, as in any prosthesis implantation. The sling can be placed via a retropubic or transobturator approach. These two approaches enjoy the same success rate but morbidity seems to be higher with the retropubic approach (bladder injury, dysuria, de novo urge incontinence). The type of anesthesia has no influence on the postoperative results. Mixed urinary incontinence, low urethral mobility, obesity, old age, and the desire for future pregnancies are situations that do not contraindicate placement of suburethral slings, but they can alter the quality of the results. Rigorous assessment of the risks and benefits as well as fair and honest information must be provided to patients in these situations. Without sufficient studies proving their efficacy and innocuousness, minislings cannot today be recommended to treat female urinary stress incontinence.