In this article Dr Girdhar S Bora, urologist at PGIMER, Chandigarh talks about the updates on single incision sling for management of Stress Urinary Incontinence.
Figure 1: Single incision slings and their properties
The single-incision sling is a less invasive procedure designed as an alternative to the trans-obturator TVT. This mini-sling is inserted via a single vaginal incision and fixed to the pelvic wall tissue with various fixation methods. It avoids the groin passage and blind tape insertion, utilizing a shorter sling length of approximately 6.5–12 cm. This approach introduces less foreign material, avoiding both the retropubic trajectory and adductor muscle perforation, thereby reducing perioperative pain and morbidity. Additionally, it can be performed under local anaesthesia.
Since 2006, various ready-made simplified tape systems have been developed. These systems are inserted into the vagina via a small colpotomy and are generally guided and attached to the obturator internus muscular fasciae in the obturator membrane directly. Attachment methods include absorbable patches (e.g., TVT Secur® by Gynecare), self-adhesive surfaces (e.g., DynaMesh SIS® minor by FEG Textiltechnik mbH), and mini-anchor systems (e.g., MiniArc Precise® by AMS, Ajust® by Bard, or Ophira® by Promedon).
Two randomized controlled trials comparing mini-slings (MiniArc) with obturator and retropubic tapes, involving 193 and 185 patients respectively, showed no significant differences in patient-reported or objective success at 36 months.(1) A third randomized controlled trial comparing mini-slings (Ajust) with obturator tapes in 368 patients showed no significant differences in subjective and objective success at one year. However, mini-slings resulted in less immediate postoperative pain, shorter operative time, and quicker recovery.(2) The SIMS trial from the UK also reported similar outcomes and found that the mini-sling procedures were more likely to be performed under local anaesthesia and although the groin or thigh pain was similar between the groups, though more women in the mini-sling group reported dyspareunia, mesh exposure, or required further surgery for urinary incontinence.(3)
A recently conducted Cochrane review concluded that single-incision slings are as likely as mid-urethral slings to cure incontinence and may be associated with less pain. However, current evidence is largely limited to 2 years of follow-up. More long-term results are needed to establish the effectiveness and safety of single-incision slings compared to other surgical treatments.(4)
Thus, single-incision slings offer a promising alternative to conventional mid-urethral slings, combining minimal invasiveness with effective continence restoration. While conventional MUS remains the gold standard with robust long-term data, SIS presents a viable option for those seeking a less invasive solution with a potentially quicker recovery period.
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