ISSN ONLINE: 2558-815X
ISSN PRINT: 1584-9244
ISSN-L: 1584-9244

Mid-urethral slings for stress urinary incontinence. Differences between transobturator and retropubic mid-urethral slings

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ABSTRACT
Nowadays, the surgical success rate for stress urinary incontinence (SUI) is approximately 90 % the mid-urethral synthetic slings being currently the most effective surgical options in women with SUI. The initial treatment should consist of conservatory measures such as pelvic floor exercises, hormonal medication or vaginal pessary, the failure or refusal of these methods will then guide the surgeon towards a surgical decision with the use of a mid-urethral sling either of retropubic or transobturator type. The choice between the two slings should be done after a complete evaluation of the urinary function taking into consideration the coexistence of a mixed incontinence, a dysfunction of the intrinsic sphincter, a rigid urethra but also the age and the weight of the patient as well as the possible previous surgical interventions for SUI. The advantages of each type of mid urethral sling and their associated complications should be preoperatively explained to the patient, the decision to opt for one or another sling depending also on the professional experience of the surgeon. The aim of this review is to present the advantages and the disadvantages of two types of mid-urethral slings – the retropubic and the transobturator sling- as well as the possible intra-and postoperative complications and their management.
Key words: stress urinary incontinence, sling, transobturator, retropubic.
Abbreviations: SUI=stress urinary incontinence;
TOT-S= transobturator mid-urethral sling; TVT= tension- free vaginal tape.

INTRODUCTION
The stress urinary incontinence (SUI) is known as a condition in which an involuntary loose of urine appears  during different activities that increase the intraabdominal pressure such as sneezing, coughing or the effort of defecation1. When the intraabdominal pressure achieves a higher level than the required pressure for the closure of the urethra, an involuntary leakage of the urine will produce. The stress incontinence represents 60% of all types of incontinence and it has been reported to affect between 4% and 35% of women2. In Switzerland, the condition is affecting almost 400 000 of women.

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