Changing trends in surgery for stress urinary incontinence

摘要

PURPOSE OF REVIEW: Currently, a number of different stress urinary incontinence (SUI) procedures exist. The relatively recent adoption of the midurethral sling into clinical practice has changed the surgical management of SUI. This critical evaluation of the trends in SUI surgery emphasizes the public health burden of SUI surgery, provides insight into modern clinical practice, determines whether these trends reflect evidence-based data, and highlights potential areas for future research. RECENT FINDINGS: Trends in SUI surgery have shown a rise in the use of midurethral mesh slings with a concomitant decrease in retropubic procedures. The rates of other types of SUI surgery remain quite low. Although the overall rate of slings has increased dramatically, limited population-based data exist regarding specific types of midurethral slings, such as retropubic vs. transobturator vs. mini-slings. There is a need for continued evaluation of these trends in response to heightened public awareness of the potential risks of synthetic mesh. SUMMARY: The midurethral sling has become the gold standard surgery for SUI. It will be important to evaluate future trends in SUI surgery given the dynamic changes in new techniques for midurethral slings and long-term evidence regarding the effectiveness and risks of specific sling types.