Mid-Urethral Slings for the Treatment of Stress Urinary Incontinence: A Systematic Review

Abstract

Introduction: Stress urinary incontinence (SUI) is a common condition affecting women. The mid-urethral sling (MUS) has become the gold standard surgical treatment. This review evaluates the long-term efficacy and safety of both retropubic and transobturator MUS procedures.

Methods: We conducted a comprehensive search for RCTs comparing retropubic (TVT) or transobturator (TOT) slings to non-surgical management, placebo, or other surgical procedures. Primary outcomes were objective and subjective cure rates.

Results: The meta-analysis of over 100 RCTs demonstrated that mid-urethral slings have high objective and subjective cure rates, ranging from 80-90% at 1 year and remaining durable at long-term follow-up. Retropubic slings had slightly higher objective cure rates but also a higher risk of bladder perforation and voiding dysfunction compared to transobturator slings.

Discussion: The mid-urethral sling is a highly effective, durable, and safe procedure for SUI. The choice between a retropubic and transobturator approach involves a trade-off between efficacy and specific complications.

Conclusion: Mid-urethral slings are a highly effective and durable surgical treatment for female stress urinary incontinence.