To determine the usefulness of mid-urethral slings (MUS) in the surgical management of women presenting with urinary stress incontinence (USI) METHOD: A consensus committee of multidisciplinary experts (CUROPF) was convened and focused on PICO questions concerning the efficacy and safety of MUS surgery compared to other procedures and concerning which approach (retropubic (RP) vs transobturator (TO)) should be proposed as a first-line MUS surgery for specific subpopulations (obese; intrinsic sphincteric deficiency (ISD); elderly) RESULTS: As compared to other procedures (urethral bulking agents, traditional slings and open colposuspension), the MUS procedure should be proposed as the first-line surgical therapy (strong agreement). MUS surgery can be associated with complications and proper pre-operative informed consent is mandatory (strong agreement). Mini-slings (SIS/SIMS) should only be proposed in clinical trials (strong agreement). Both RP and TO approaches may be proposed for the insertion of MUS (strong agreement). However, if the woman is willing to accept a moderate increase in per-operative risk, the RP approach should be preferred (strong agreement) since it is associated with higher very long-term cure rates and as it is possible to completely remove the sling surgically if a severe complication occurs. The RP approach should be used for the insertion of MUS in a woman presenting with ISD (strong agreement). Either the RP or TO approach should be used for the insertion of MUS in an obese woman presenting with USI (strong agreement). In very obese women (BMI ≥35-40kg/m2), weight loss should be preferred prior to MUS surgery and bariatric surgery should be discussed (strong agreement) CONCLUSION: The current Opinion provides an appropriate strategy for both the selection of patients and the best therapeutic approach in women presenting with USI.
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2021 Dec 14 [Epub ahead of print]
V Cardot, S Campagne-Loiseau, P Roulette, L Peyrat, A Vidart, L Wagner, C Thuillier, J Klap, S Hurel, J F Hermieu, F Girard, L Even, L Donon, T Charles, B Tibi, P O Bosset, N Berrogain, F Meyer, J-N Cornu, X Deffieux
Clinique de Meudon-Clamart, 3, avenue de Villacoublay, 92360 Meudon, France., Service de gynécologie obstétrique, CHU Estaing, Clermont Ferrand, 1, place Lucie et Raymond-Aubrac, 63000 Clermont Ferrand, France., Service d'urologie, CH Cahors, 30, avenue de la voie Romaine, 06000 Nice, France., Service d'urologie, Clinique de Turin, 13, rue de Turin, 75008 Paris, France., Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France., Servie d'urologie, CHU Carémeau, place du Pr Robert Debré, 30029 Nîmes, France., Service d'urologie, CHU Grenoble-Alpes, 38000 Grenoble, France., Service d'urologie, hôpital Privé Claude Galien, 20, route de Boussy Saint-Antoine, 91480 Quincy sous Sénart, France., Service d'urologie, hôpital Européen Georges-Pompidou (AP-HP), 20, rue Leblanc, 75015 Paris, France., Service d'urologie, hôpital Bichat (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France., Service d'urologie, clinique oudinot fondation Cognacq-Jay, 2 rue Rousselet, 75007 Paris, France., Cabinet d'urologie, Espace Santé 3, 521, avenue de Rome, 83500 La Seyne-sur-Mer, France., Service d'urologie, Polyclinique de la Côte Basque Sud, 7, rue Léonce Goyetche, 64500 Saint Jean de Luz, France., Service d'urologie, CHU La Miletrie, 2, rue de la Milétrie, 86021 Poitiers, France., Service d'URologie, Clinique Ambroise Pare, 387, route de Saint-Simon, 31100 Toulouse, France., Service d'urologie, hôpital Saint Louis (APHP), 1, avenue Claude Vellefaux, 75010 Paris, France., Service d'urologie, hôpital Charles-Nicolle, université de Rouen, 1, rue de Germont, 76000 Rouen, France., Service de gynécologie obstétrique, hôpital Antoine-Béclère (APHP), 157, rue de la Porte de Trivaux, 92140 Clamart, France. Electronic address: .