[Place of the mini-sling in the treatment of female stress urinary incontinence]

OBJECTIVE

Evaluate the place of sub-urethral mini-slings in the treatment of female stress urinary incontinence.

MATERIAL AND METHODS

Review of the literature on 43 publications (comparative and prospective studies) more than 6443 patients who underwent for the treatment of urinary incontinence, a mini-strip type TVT®, TVT-S®, MiniArc®, Ajust®, Needleless®, Solyx®, or Ophira® in comparison to the conventional urethral sling. The comparison used objective (cough stress test and pad weight test) and subjective criteria (quality of life questionnaire). The papers have also studied the complication associated with these new techniques.

RESULTS

The overall effectiveness of this surgery varied between 40 to 84% for TVT-S®, 69 to 92% for MiniArc®, 80 to 91% for Ajust®, 87% for Needleless®, 95% for Solyx® and 85% for Ophira®. The efficacy on incontinence was higher with the TVT® TVT-S® and the MiniArc® (P=0.01 to 0.05). TVT-O® efficacy was higher than TVT-S® (P<0.01 and P=0.02). Conventional slings seems to be more efficient than TVT-S® and MiniArc® mini-slings. Ajust® mini-sling seems to be as efficient as MiniArc® and TVT-S® mini-sling and TVT-O®. It showed a decrease in the intensity of postoperative pain (P<0.001), faster return to normal activities (P=0.025) and use of a common local anesthetic to the adjustable mini-sling.

CONCLUSION

It seems that the adjustable mini-sling is currently the best compromise in terms of effectiveness and complications if the choice had to be among the mini-sling in the treatment of stress urinary incontinence.

Anatomic relationships of single-incision midurethral slings

OBJECTIVE

The objective of the study was to evaluate the anatomic relationships of anchor points of single-incision midurethral slings with 2 common placement trajectories.

STUDY DESIGN

In 30 female pelvic halves, a probe was introduced through a suburethral tunnel following 45° and 90° angle trajectories. The corresponding anchor points were tagged. Distances to the obturator canal, accessory obturator vessels, dorsal vein of clitoris, and external iliac vein were recorded.

RESULTS

Both suburethral tunnel trajectories and their respective anchor points remained caudad to the obturator internus muscle in 100% of dissections. The closest distance between either anchor point to the obturator canal was 1.6 cm. The closest distance from the 45° and 90° anchor points to the accessory obturator vessels was 1.6 and 1.5 cm, respectively.

CONCLUSION

The anchor points of single-incision midurethral slings are in close proximity to vascular structures that could be injured with inadvertent entry into the retropubic space.