Sling Surgeries for Incontinence(TOT/TVT/PVS)

Sling Surgeries for Incontinence(TOT/TVT/PVS)

Stress urinary incontinence (SUI) is a common health problem, with the prevalence rate ranging from 12.8% to 46.0%. SUI has a major impact on the quality of life (QOL) of many women, and it represents a major economic burden globally. Various therapeutic options are available to alleviate this problem, and surgical correction is used for women with SUI in whom conservative management strategies have failed.

The midurethral sling (MUS) is the most commonly performed surgical treatment and has been considered as a gold standard for treating patients with SUI. The pubovaginal sling (PVS) was described in the early 20th century and was brought into wide clinical use by Drs E.J. McGuire and B. Lytton in the late 1970s. Thereafter, the tension-free vaginal tape (TVT) procedure was developed in 1996 by Dr U. Ulmsten and colleagues. In 2001, Dr E. Delorme introduced the outside-in transobturator tape (TOT) method, in which the needle is penetrated through the skin to the vaginal anterior wall, and in 2003, Dr J. de Leval described the inside-out TVT-obturator (TVT-O) method. In an attempt to minimize postoperative complications further and reduce the need for anesthesia, single-incision slings, such as tension-free vaginal tape SECUR (TVT-S), have been developed.

Therefore, a broad spectrum of options exists for patients with SUI who undergo surgical treatment. However, in clinical practice, choosing the most appropriate sling therapy for treating different groups of SUI patients is challenging. The objective of this study was to summarize the associations between patient conditions and the MUS procedure chosen. Here, we reported the patient conditions that are considered most appropriate for each MUS procedure, including TVT, TVT-O, TVT-S (Johnson & Johnson Medical (China) Ltd, Shanghai, China), and PVS, to ensure the best outcome.