Improved techniques and products: sling surgery ranks as first-rate option for SUI.(Gynecology)

LAKE BUENA VISTA, FLA. -- Improvements in techniques and products have elevated sling surgeries to a first-line option for stress urinary incontinence treatment, said Dr. Joseph L. Maccarone at a conference on gynecologic surgery sponsored by the Cooper University Hospital.

"Stress incontinence responds best to surgical therapies," said Dr. Maccarone, head of the division of female pelvic medicine and reconstructive surgery at the Robert Wood Johnson Medical School at Camden (N.J.).

For patients with intrinsic sphincteric deficiency (ISD) and a mobile urethra, or for patients with a normal urethra, he suggests a Burch procedure or sling, depending on comorbidities. He prefers injectables for patients with a weak, fixed urethra.

Slings can correct urethral hypermobility and provide a backboard against which the urethra is compressed. They can be performed at the same time as other procedures.

Dr. Maccarone says he prefers slings for high-risk patients, including smokers, obese women, those with occupations that require heavy lifting, and women with chronic constipation, chronic steroid use, ISD, or failed anti-incontinence surgery. He also recommends slings for patients without significant prolapse who want an outpatient solution and for women with prolapse who desire an all-vaginal approach.

Patients who are unwilling or unable to perform self-catheterization are not candidates for slings. Other contraindications include an atonic detrusor with an elevated postvoid residual, uncontrolled and severe detrusor instability, vesicoureteral reflux, vesico- or urethrovaginal fistula, or a history of pelvic radiation.

Both organic and synthetic sling materials exist, and each material has merits and drawbacks. Organic products decrease the risk of infection and erosion and may promote regeneration of the native tissue. But the body may degrade the sling over time, and concerns remain about disease transmission and availability.