Single vs standard slings for stress incontinence

This study compared the long term effectiveness of single incision mini slings against standard mid-urethral slings in female patients with stress urinary incontinence. This study concluded that long term standard mid-urethral slings are more effective but single incision mini slings show reduced complications after surgery in women with stress incontinence.

Stress incontinence is urine leakage when there is pressure on the bladder. It is often observed when a patient coughs, sneezes or exercises. Stress incontinence happens as a result of weak muscles around the bladder that hold urine in.

Urinary incontinence can be treated by pelvic floor exercises, drug therapy, pessaries (to support the walls of the bladder) or nerve stimulation. Surgery can also be an option when these treatments do not work, but it is only effective for stress incontinence.

Surgical slings are used for surgery for stress incontinence. Most stress incontinence problems are caused by bladder neck weakness. Surgeons insert a sling which then supports the bladder neck and stops urine leakage.

Standard mid-urethral slings (SMUS) have been the standard surgical procedure for stress incontinence. This involves tape or mesh supporting the bladder neck and being held in place by the surrounding tissues. This method can lead to significant side effects. Single incision mini slings (SIMS) are being tested to see if they can reduce these side effects while still being effective.

Database searches were carried out for studies comparing SMUS and SIMS in women with stress urinary incontinence. 29 studies including 2986 women were analyzed.

Long term after surgery, objective tests showed SMUS to have a better cure rate for stress incontinence. Patients' reports showed no difference between SMUS and SIMS. Four studies showed better quality of life after SMUS surgery, than SIMS surgery. No difference in sexual function was observed between SMUS and SIMS. 16 studies reported lower pain after SIMS surgery versus SMUS surgery, up to 7 days after surgery. However, there was no difference between SIMS and SMUS patients pain 30 days after surgery.  There was no difference between SIMS and SMUS for complications such as bladder injury, urinary tract infections, urinary retention, groin pain, urgency, vaginal erosion (damage to the vagina), tape release or re-operation.

This study concluded that SMUS is more effective in the long term than SIMS for stress incontinence in women. SIMS however, has a shorter operation time, less urinary bladder weakness, and less bleeding and pain after surgery.

The studies used different questionnaires to measure the effects of the surgeries on quality of life and sexual function. These different questions may affect the comparison of SIMS and SMUS surgery.