[Suburethral sling procedures for stress urinary incontinence].
The rational of the surgical treatment of female stress urinary incontinence has changed over the past few years. The techniques of colposuspension have been replaced by the suburethral slings, retropubic initially with the TVT, recreating a backboard between the urethra and the vaginal anterior wall. Nevertheless with overall cure rates of 69% to 88%, in periods beyond 5 years, the colposuspension still remains the reference (high-grade scientific evidence). Based on observational studies (low quality scientific evidence), with generally a short follow-up, the results of the TVT appear similar. More recently, the suburethral transobturator tape (TOT) was introduced to reduce the complications of the TVT. It is thus difficult to currently have an objective idea of the effectiveness of the TOT compared to the TVT, even if the first impressions, with respect to the TOT, are rather favourable. Furthermore the TOT technique itself and the biomaterials used, have continued to evolve. In fact, if the complications of these two kinds of suburethral slings are different: bladder perforation for the TVT, prosthetic erosion for the TOT, in contrast, in the future, their indications could be different. Therefore the TVT appears more effective in presence of intrinsic sphincter deficiency with urethral hypermobility.
Clinique gynécologique et obstétricale, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen, France. fabrice.sergent@chu-rouen.fr
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F
Sergent
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G
Gay-Crosier
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L
Marpeau
D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019919:Prosthesis Implantation / Q000379:methods*; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*