In 1995, Petros and Ulmsten [1] introduced a new, minimally invasive surgery for the treatment of female stress urinary incontinence (SUI), namely the tension-free vaginal tape (TVT) procedure. Based on the integral theory, continence can be achieved by placing a vaginal tape underneath the midurethra without tension to reinforce the weakened pubourethral ligament [2]. It has become one of the most popular procedures for female SUI because of its excellent results [1, 3] However, the common use of the TVT has been associated with various operative complications, including bladder perforation [4], major blood vessel injuries [5], and postoperative voiding difficulties [6].
　　In an attempt to reduce the morbidity of retropubic needle passage, an alternative approach with transobturator route of the prolene tape (TOT) has been developed by Delorme [7]. Subsequently, De Leval designed a TOT inside-out procedure (TVT-O) [8] in 2003. In theory, the TOT sling lies in midurethra at less of an acute angle compared to the TVT, and it is not likely to obstruct urine flow during voiding. However, this transobturator procedure does not completely eliminate the risks of bladder perforation or tape erosion [9].
　　With comparable objective cure rates, TVT-O had the advantages over TVT with shorter operative time and relatively lower complication rate. However, TVT-O tape was at less of an acute angle and localized to a more distal part of urethra, resulting in less urethral compression and a lower rate of urethral kinking [10]. Therefore, urethral dynamic kinking appeared to play an important role in the mechanism of postoperative continence.
　　In an effort to maintain efficacy while eliminating some of the side effects, a new generation of slings has been developed, called ’single incision slings’ or ’mini-slings’; these slings are the subject of this review. They are designed to be shorter (in length) than standard mid-urethral slings and do not penetrate the tissues as deeply as standard slings. It was therefore thought that they would cause fewer side effects while being no less effective. Examples of single-incision slings include TVT-Secur, MiniArc, Ajust and Needleless slings, among others.
　　Comparing other single-incision slings versus standard mid-urethral slings were too few to allow meaningful comparisons. Some evidence suggests that single-incision slings were quicker to perform and may cause less postoperative pain, but more trials are needed to adequately assess whether the other types of mini-slings are in fact as good as or safer than standard mid-urethral slings [11].
References
1.Nilsson CG, Kuuva N, Falconer C, Rezapour M, Ulmsten U. Long-term results of the tension-free vaginal tape (TVT) procedure for surgical treatment of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12 Suppl 2:S5-8.
2.Petros PE, Ulmsten UI. An integral theory and its method for the diagnosis and management of female urinary incontinence. Scand J Urol Nephrol Suppl. 1993; 153:1-93.
3.Nilsson CG, Falconer C, Rezapour M. Seven-year follow-up of the tension-free vaginal tape procedure for treatment of urinary incontinence. Obstet Gynecol. 2004; 104:1259-62.
4.Meschia M, Pifarotti P, Bernasconi F, Guercio E, Maffiolini M, Magatti F, et al. Tension-Free vaginal tape: analysis of outcomes and complications in 404 stress incontinent women. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12 Suppl 2: S24-7.
5.Kuuva N, Nilsson CG. A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand 2002;81: 72-7.
6.Long CY, Lo TS, Liu CM, Hsu SC, Chang Y, Tsai EM. Lateral excision of tension-free vaginal tape for the treatment of iatrogenic urethral obstruction. Obstet Gynecol 2004;104:1270-4.
7.Delorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol 2001;11:1306-13.
8.de Leval J. Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol 2003;44:724-30.
9.Abdel-Fattah M, Sivanesan K, Ramsay I, Pringle S, Bjornsson S. How common are tape erosions? A comparison of two versions of the transobturator tension-free vaginal tape procedure. BJU Int. 2006;98:594-8.
10.?Long CY, Hsu CS, Lo TS, Liu CM, Chen YH, Tsai EM. Ultrasonographic assessment of tape location following tension-free vaginal tape and transobturator tape procedure. Acta Obstet Gynecol Scand 2008;87:116-21.
11.Nambiar A, Cody JD, Jeffery ST. Single-incision sling operations for urinary incontinence in women.Cochrane Database Syst Rev. 2014 Jun 1;(6):CD008709.