UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

SLING PROCEDURES (STRESS URINARY INCONTINENCE TREATMENT)

Özge Nur Gülen

Kartal Dr. Lütfi Kırdar City Hospital, Department of Gynecologic Oncology, İstanbul, Türkiye

Gülen ÖN. Sling Procedures (Stress Urinary Incontinence Treatment). In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.157-168.

ABSTRACT

Stress urinary incontinence (SUI) represents a prevalent urological condition with significant impact on female quality of life, characterized by involuntary urinary leakage during activities that elevate intra-abdominal pressure. The midurethral sling (MUS) procedure has emerged as the surgical gold standard for SUI management, due to its minimally invasive nature, robust safety profile, and sustained long-term efficacy. Among various approaches, the transobturator technique-developed as a modification to the traditional retropubic pathway-was designed to mitigate complications associated with retropubic access, notably injuries to the bladder, bowel, and vascular structures. This chapter presents an in-depth analysis of the transobturator MUS technique, encompassing both the inside-out (TVT-O) and outside-in (TOT) variants. It delineates the anatomical rationale and biomechanical principles that underlie these approaches, and systematically reviews the surgical methodology, including patient positioning, trocar trajectory, sling placement, and tensioning strategies. Criteria for patient selection, preoperative optimization, and intraoperative considerations-such as the selective use of cystourethroscopy-are critically appraised. The discussion extends to the spectrum of complications observed in the immediate and delayed postoperative periods, including voiding dysfunction, mesh erosion or exposure, groin or thigh pain, and sexual dysfunction. Evidence-based strategies for complication management are provided, informed by contemporary guidelines and high-level clinical evidence. Outcome data from multicenter trials and meta-analyses are synthesized to highlight rates of symptomatic and objective cure, durability of treatment effect, and risk of reintervention. In conclusion, transobturator midurethral sling surgery remains a cornerstone in the surgical treatment of SUI, offering a high therapeutic index when performed with precise technique and appropriate patient selection. This chapter serves as a comprehensive resource for urologists and urogynecologists aiming to refine their operative practice in accordance with current standards and evidence-based refinements in transobturator sling placement.

Keywords: Stress urinary incontinence (SUI); Midurethral sling (MUS); Transobturator sling procedure; Synthetic mesh complications; Female pelvic floor reconstruction

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