Sling Surgery for Stress Incontinence Can Be Almost Non-Invasive

As many as a third of all US women suffer from some degree of stress urinary incontinence – the involuntary leakage of urine on effort, exertion, sneezing, coughing, or laughing.  The condition can cause considerable social distress and embarrassment.  Treatment includes exercises for the pelvic floor muscles (Kegel exercises), weight control, and medications.  When these fail (and they often do), surgery is the remaining option.

There are several types of surgery for stress incontinence.  Sling operations, which are the favorite method, involve strips of material placed below the urethra and anchored each side.  When the woman strains the sling tightens, supporting the bladder.  UK experts have reviewed reports of minimally invasive sling operations and just published their findings in the Cochrane Review.

Sixty-two controlled clinical trials of minimally invasive sling surgery were reviewed.  A total of   (This procedure is done under local anesthesia by inserting a synthetic material, using a needle, underneath the urethra; it is not fixed to the muscles or ligaments.)    The trials compared this method with the open surgical approach or with a laparoscopic approach (i.e. access through a small incision in the abdominal wall).

Short-term cure rates of 80% were obtained with both open surgery and the minimally-invasive method.  The latter, however, had fewer operative complications, less difficulty with postoperative voiding, shorter operative times and hospital stays, but more frequent perforations of the bladder – a non-serious ‘complication’.

Similar benefits of the minimally-invasive procedure were found in the comparison with the laparoscopic approach.  Mesh monofilament tapes had better results than other types of sling material.

The reviewers found a major weakness of all the trials was lack of good long-term follow-up data.  However, one can conclude that there’s good evidence that minimal procedures are safe and effective; no woman with stress incontinence should be afraid of visiting a urological surgeon to get a relatively ‘easy fix’.