Female Stress Urinary Incontinence (SUI)
In the past, several different surgical procedures have been developed for surgical treatment of women with stress urinary incontinence (SUI). Because of their high effectiveness and minimal invasiveness, midurethral slings (MUS) nowadays represent a gold standard for SUI treatment. There are several different forms of MUS available, from retropubic and transobturator approaches to intraobturator single incision slings, also called “minislings”. The aim of our video is to present a relatively new variation in SUI treatment – a minimally invasive midurethral sling with no needles or anchors.
The procedure can be performed in local anaesthesia and intravenous analgesia with patient in lithotomy position. Foley catheter is placed into the bladder. Then, approximately 20 ml of 0.5% xylocaine is applied under the urethra and towards both vaginal fornices, providing both anaesthesia and hydro-dissection at the same time. Additional 10 mL of 0.5% xylocaine is applied towards obturator membrane on each side. A vertical, approximately 1 cm long incision is made under the urethra. Next, vaginal wall is dissected towards the inferior pubic ramus on each side using dissection scissors. The T-pocket of the needleless midurethral sling (Contasure-Neddleless® single incision sling, Neomedic, Barcelona, Spain) are folded and surgical forceps with the tape is inserted into the dissected space just like with the standard minisling procedures. When the fascia of the internal obturator muscle is perforated with the forceps, the forceps is opened in order to extend the pocket inside the muscle fibres and enable sling fixation. In the end, vaginal wall incision is sutured using interrupted absorbable sutures.
In our experience, single incision needleless sling placement in a safe procedure that can be performed in local anaesthesia with concomitant intravenous analgesia. Patients can be discharged on the day of the surgery and quickly return to their daily activities. The tape of the needleless sling is longer than in conventional minislings and has a T-pocket positioning system located at both edges. These pockets enable fixation of the sling to the surrounding tissue in order to achieve the proper ingrowth and anchoring. A prospective, single-centre study from 2014 showed that medium to long-term term results of needleless sling were similar to those of the TVT-O group with comparable complication and satisfaction rates . However, further studies will have to evaluate the long-term effectiveness of these procedures.
Single incision needleless slings are relatively can be performed in local anaesthesia and as outpatient procedures. Although they seem to provide good cure rates in the medium to long-term, further studies will have to address their long-term effectiveness.