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Mid-urethral tapes for genuine stress incontinence

25 September 2015

Last updated on 25 September 2015


Many Fellows will be aware that ‘class action’ legal proceedings are underway regarding mesh and, possibly, mid-urethral tapes.

A ‘class action’ is a legal proceeding brought by one person on behalf of a group of people, and class actions are used to enable a dispute involving a large number of potential litigants to be resolved through a single case.

Such legal proceedings, even if undertaken against the manufacturers of a product, will naturally be of concern to Fellows using products and implants that could potentially be the subject of cases.

The use of mid-urethral tapes to treat genuine stress incontinence is established as a safe and effective treatment. Many studies of the technique have been performed, and the most recent Cochrane review has concluded that:

“Mid-urethral sling operations have been the most extensively researched surgical treatment for stress urinary incontinence (SUI) in women and have a good safety profile. Irrespective of the routes traversed, they are highly effective in the short and medium term, and accruing evidence demonstrates their effectiveness in the long term. This review illustrates their positive impact on improving the quality of life of women with SUI. With the exception of groin pain, fewer adverse events occur with employment of a transobturator approach. When comparing transobturator techniques of a medial-to-lateral versus a lateral-to-medial insertion, there is no evidence to support the use of one approach over the other. However, a bottom-to-top route was more effective than top-to-bottom route for retropubic tapes. A salient point illustrated throughout this review is the need for reporting of longer-term outcome data from the numerous existing trials. This would substantially increase the evidence base and provide clarification regarding uncertainties about long-term effectiveness and adverse event profile.” 1

As such, and at this time, the evidence favours use of mid-urethral tapes in appropriately selected women who have been carefully counselled.

Important points to consider when managing women with genuine stress incontinence are careful assessment and precision with diagnosis, and this may involve the use of urodynamic studies in addition to history and examination findings.  Attention should be given to treatment of aggravating factors such as chronic cough, smoking, overweight, and physical inactivity. This will likely involve a multidisciplinary approach including health professionals such as physiotherapists and dietitians. 

Selective use of surgery, and careful follow-up have been shown to be beneficial and to have a favourable profile of complications and side effects.  Guidelines on training have been addressed elsewhere by the College.

References

  1. Ford AA, Rogerson L, Cody JD, Ogah J. Mid-urethral sling operations for stress urinary incontinence in women, Cochrane Database Syst Rev. 2015;7:CD006375. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006375.pub3/abstract



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