[Synthetic suburethral sling in the treatment of stress urinary incontinence in women].
Since the marketing and success of the TVT technique, other products have been released onto the suburethral sling market. These products can be classified according to four main criteria: TAPE: The material used in every case is polypropylene, in the form of woven monofilaments (TVT, Sparc, Monarc, Uretex Sup), multi-filaments (IVS, Safyre comprising two silicone tension bands), extruded crosslinked polypropylene (Obtape) or silicone-coated polypropylene in contact with the urethra (Uratape). A larger space between the fibres is associated with a lower theoretical risk of infection and better tissue ingrowth. The weaving process of Uretex Sap tape decreases the warping and release effect. Extruded polypropylene forms a very solid, but poorly elastic tape. It is not yet clear whether silicone-coating is an advantage or a disadvantage.
The ascending retropubic approach (TVT, Uretex Sup, IVS) is now well known. It carries a risk of bladder perforation and, more exceptionally, intestinal or vascular injuries. The descending retropubic approach (Uretex Sup, Sparc) requires more extensive vaginal dissection and carries a risk of bladder perforation. The mixed retropubic approach (Uretex Sup) combines the potential disadvantages of the ascending and descending approaches. The transobturator approach (Uratape, Obtape, Monarc) was described more recently and is easy to learn. It does not carry any risk of intestinal or vascular injury, but the urethra, vagina or even the bladder (in the case of lateral cystocele) can be damaged by this incision.


METHODS
Ease of use is an essential feature. Uretex Sup comprises ancillary instruments and a technique requiring multiple manipulations. Sparc tape cannot be easily dissociated from the ancillary instruments when a second passage is necessary. TVT and Uratape use resterilizable instruments, while the other products are totally disposable. FOLLOW-UP AND PUBLICATIONS: Only TVT has a sufficient follow-up and several hundred specific papers or publications. Only a few publications by a few different teams are currently available for the other products. In conclusion, the various published studies confirm the qualities and good tolerance of woven monofilament polypropylene. The other materials require a longer follow-up and more studies before they can be completely validated in terms of results and morbidity. The multiple surgical approaches and the various ancillary instruments available allow the technique to be adapted to each patient and each surgeon, regardless of his or her initial training and habits.
Hermieu
Jean-François
JF
Clinique Urologique, Hôpital Bichat, 46, rue Henri Huchard, 75018 Paris. jean-francois.hermieu@bch.ap-hop-paris.fr
Milcent
Stéphane
S
D001672:Biocompatible Materials; D005260:Female; D006801:Humans; D011126:Polypropylenes; D013526:Surgical Mesh; D014521:Urethra; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
D001672:Biocompatible Materials; D011126:Polypropylenes