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Surgical management of stress urinary incontinence in women: Retropubic midurethral slings

Authors
Charles W Nager, MD
Jasmine Tan-Kim, MD
Section Editor
Linda Brubaker, MD, FACS, FACOG
Deputy Editor
Kristen Eckler, MD, FACOG

INTRODUCTION

Stress urinary incontinence (SUI) affects 4 to 35 percent of women [1,2]. SUI occurs when an increase in intraabdominal pressure exceeds urethral closure pressure, resulting in the involuntary leakage of urine. This may occur with exertion, sneezing, or coughing [3].

Management options for SUI include conservative and surgical treatments. Midurethral sling placement has replaced other procedures (eg, retropubic colposuspension, bladder neck slings) as the procedure of choice for many women [4]. The tension-free vaginal tape (TVT), introduced by Ulmsten in 1996, was the first synthetic retropubic midurethral sling [5]. Since that time, variations of retropubic midurethral slings as well as midurethral transobturator slings have been introduced.

Retropubic midurethral sling procedures are reviewed here. Transobturator midurethral slings and the approach to choosing a procedure for SUI in women are discussed separately. (See "Surgical management of stress urinary incontinence in women: Transobturator midurethral slings" and "Surgical management of stress urinary incontinence in women: Choosing a primary surgical procedure" and "Surgical management of stress urinary incontinence in women: Choosing a type of midurethral sling".)

TERMINOLOGY

There are several types of sling procedures for treatment of SUI in women (table 1). These procedures vary by the location of the sling and by the sling material. Collectively, these slings are referred to as suburethral slings, which is a sling that is inserted through a small vaginal incision and attached to another structure in the pelvis for the purpose of supporting the urethra. Suburethral slings may be either bladder neck or midurethral slings.

Midurethral sling – A suburethral sling that is placed at the level of the midurethra in a tension-free manner. These slings are made of synthetic mesh.

                                             

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