Single incision slings: Past, present, and future

Abstract

Pubovaginal slings have become the gold standard to treat stress urinary incontinence. Traditionally, the sling referred to a suspensory that was placed under the urethra and brought through the retropubic space and anchored on either side of the midline. Since this original concept, there have been many materials used for the sling, and there have been many different anchoring approaches. Most agree that one of the best materials is polypropylene mesh. However, the means of anchoring the device and where best to have this anchorage placed is debatable. The options for anchoring simply include using darts vs not to hold the sling in place. The location of this anchorage, on the other hand, is much more controversial. The main locations are retropubic, transobturator, and via a single incision. The obturator and retropubic slings have become the standard of care over time. The single incision sling, on the other hand, is starting to be more acceptable which has resulted in it being used more frequently. The single incision relies on mainly anchoring the sling through the obturator internus muscle with possible inclusion of the obturator membrane. The purpose of this review article is to present the data that exists for the use of the single incision sling.

Keywords: Sling; Stress urinary incontinence; Incontinence; Single incision sling; Surgery

Core tip: Polypropylene slings have become the mainstay of therapy for treating stress urinary incontinence in women. Historically, these slings have worked well, but there was always the concern of morbidity. The goal of the single incision sling (SIS) is to provide high efficacy with minimal side effects. The initial use of the SIS was mottled by confusion with the techniques for deployment. The most recent data has shown that when the SIS is used appropriately the success rates are similar to standard mid-urethral slings with minimal risk of bladder, vascular, or nerve injury as well as chronic pain.