Summary by David Castro Diaz
This was a very informative and thought provoking session discussing some hot issues of surgery for stress urinary incontinence (SUI). In two different systematic reviews and meta-analysis evaluating Urodynamics (UDS) before surgery for SUI, it was observed that preoperative UDS do not influence the surgical outcome of surgery being unproven the clinical benefit from this invasive investigation. In my opinion this is a controversial issue as although it is clear that the reliability of preoperative UDS is rather poor for patients with pure and uncomplicated SUI, it is also true that some benefit might be obtained if complications related to voiding function occur after the procedure. Data of a randomized trial comparing outcomes of retropubic (TVT) with transobturator (TOT) mid urethral sling (MUS) showed that although both TVT and TOT are effective options for the treatment of SUI, outcomes after TOT tend to decline over time while it is stable after retropubic TVT. However there are some limitations in this study because TOT group also included data from the “obtape” mesh which is no longer available. Finally a systematic review and meta-analysis evaluating the outcome of single-incision mini-slings (SIMS) versus standard MUS in the management of SUI concluded that, excluding TVT-Secur, SIMS show no significant differences in patient-reported and objective cure rates but superior recovery time when compared to standard MUS with 12-24 months follow-up. In any case these data should be interpret results with caution until there is longer-term follow-up before considering SIMS as primary treatment for women with SUI.