Place of the mini-sling in the treatment of female stress urinary incontinence

Objective. - Evaluate the place of sub-urethral mini-slings in the treatment of female stress urinary incontinence. Material and methods. - Review of the literature on 43 publications (comparative and prospective studies) more than 6443 patients who benefited a mini-sling sub-urethral in stress urinary incontinence TVT (R), TVT-S (R), MiniArce (R), Ajust (R), Ophira (R), Needleless (R), Solyx (R) in comparison to conventional urethral sling. The comparison used objective (cough stress test and pad weight test) and subjective criteria (questionnary of quality of life). The papers have also studied the complication associated with these new techniques. Results. - The overall effectiveness of this surgery varied between 40 to 84% for TVT-S (R), 69 to 92% for MiniArc (R), 80 to 91% for Ajust (R), 87% for Needleless (R), 95% for Solyx (R) and 85% for Ophirae (R). The efficacy on incontinence was higher with the TVT (R) TVT-S (R) and the MiniArc (R) (P = 0.01 to 0.05). TVT-O (R) efficacy was higher than TVT-S (R) (P < 0.01 and P = 0.02). Conventional slings seems to be more efficient than TVT-S (R) and MiniArc (R) mini-slings. Ajust (R) mini-sling seems to be as much efficient as MiniArc (R) and TVT-S (R) mini-sling and TVT-O (R). It showed a decrease in the intensity of postoperative pain (P < 0.001), faster return to normal activities (P = 0.025) and use of a common local anesthetic to the adjustable mini-sling. Conclusion. - It seems that the adjustable mini-sling is currently the best compromise in terms of effectiveness and complications if the choice had to be among the mini-sling in treatment of stress urinary incontinence. (C) 2013 Elsevier Masson SAS. All rights reserved.