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Review article

Compendium of sling operative techniques in the treatment of stress urinary incontinence in women

Krešimir Živković ; Klinički bolnički centar Zagreb
Ana Zelić ; Ordinacija opće medicine dr. Vesna Plešić, Šibenik
Nikica Živković ; Opća bolnica Šibensko-kninske županije, Odjel za ginekologiju i porodništvo
Petar Lozo ; Ginekološka poliklinika Lozo, Zadar

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page 119-128

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Incontinence of urine is a common condition, especially in women, affecting the quality of everyday life.
Up to 50% of elderly women are affected. The etiology of this condition is not known entirely, although it is often linked to vaginal delivery. During vaginal delivery, the pelvic organs lose their original position, due to overstretching or damage of muscles and fasciae. Overweight women, as well as those in peri- and postmenopause, due to low estrogen levels, suffer more frequently of this condition. In the early 1990s the Integral theory by Petros and Ulmsten demarked a turning point in the development of new minimally
invasive sling methods. All types of stress urinary incontinence (SUI) can be treated by sling methods, which, in turn, are a golden standard for the treatment of this condition. These new, minimally invasive methods, can fully replace older, classic operations for treatment of SUI, without any concern of deficient results. This review intended to put emphasis on the comparison of these sling methods, in order to see if they are equally successful, and if there is a difference in the risk of complications. Sling methods taken into
account are TVT (Tension free Vaginal Tape), TOT (Transobturator Tape) method, and TVT-O (Tensionfree Vaginal Tape-Obturator), as well as the newest method MiniArc®. The TVT method includes placing a mesh tape, retropubic, under the middle third of the urethra. This method is from 86% to 99% effective. The TOT method was developed in order to decrease complications associated to penetrating through the retropubic space, which are more common when using TVT. Further on, a newer technique, in which the
sling passes from “inside-out” the TVT-O, is an alternative to the TOT method, since it minimizes the possibility of complications associated to the TOT. The latest technique, MiniArc®, is an extension of the
endeavor to create the least invasive method for SUI treatment, but more extensive data about this method is required. All sling methods are equally effective and women report a higher quality of life after undergoing a sling procedure. To conclude, it can be said that the transobturator approach is less likely to develop severe complications than the retropubic approach.


female urinary stress incontinence, minimally invasive procedures, suburethral sling

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