Can the mini-sling become the golden standard for treating stress urinary incontinence?
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EDITORIAL
Can the mini-sling become the golden standard for treating stress urinary incontinence? Cheng-Yu Long 1 & Gin-Den Chen 2 & Rebecca G. Rogers 3 Received: 23 November 2019 / Accepted: 25 January 2020 # The International Urogynecological Association 2020
The evolution of anti-incontinence surgeries is dramatic, and innovative paradigms change frequently. In the late 1990s, r e t r o p u b i c m i d u r e t h r a l s li n g s o v e r t o o k B u r c h ’ s colposuspension to become the gold standard for surgical treatment of female urinary incontinence (SUI). In the past 2 decades, the second generation of the mid-urethral sling, transobturator tape, has proved to be as effective as retropubic midurethral slings with fewer intraoperative complications. Recently, the third generation of the mid-urethral sling, the mini-sling (using less mesh), has attracted attention because this procedure avoids passing trocars through the space of Retzius or through the obturator foramen. Theoretically, these procedures avoid bladder perforation and major vessel injury, which may occur during retropubic procedures, and postoperative thigh and groin pain, which may occur after transobturator procedures. Two randomized clinical trials comparing the mini-sling to TVT-O published in the IUJ reveal similar efficacy, safety and mesh erosion rates between the two procedures. In addition, the trials found that women who underwent a mini-sling procedure reported lower intensity and a shorter duration of postoperative pain after 2 and 3 years of follow-up [1, 2]. Length of vaginal tape (12 cm vs. 19 cm) seems to be the main factor that influences the amount of postoperative pain. This may be due to less neuro-muscular injury by reducing the depth of
* Gin-Den Chen [email protected] 1
Department of Obstetrics and Gynecology, Kaohsiung Municipal Siaogung Hospital, Kaohsiung, Taiwan
2
Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, 110, Jianguo N Rd, Section 1, Taichung 402, Taiwan
3
Department of Women’s Health, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
lateral dissection, avoiding perforation of the obturator membrane with scissors or a guide and the presence of the tape beneath the groin. One study used the Pelvic Organ Prolapse/ Urinary Incontinence Sexual Questionnaire to evaluate sexual function after surgery and found that sexually active women had improved sexual function and no significant change in pain during intercourse following these procedures. Mesh exposure following its use is important. In these two trials, rates of mesh exosure for the mini-sling were 2% and 4.9% in 3 years of follow-up, respectively [2, 3]. Another 24month follow-up study showed 3.37% of mesh exposure was ≤ 1 cm, and 2.24% was > 1 cm according to the IUGA/ICS Classification of Prosthesis-related Complications [1]. The mesh exposure rates of this product are similar to those of the classical mid-urethral sling in mid-term follow-up. However, the questions that remain are whether
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