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Abstract: Introduction: Since the introduction of the first retropubic tension-free synthetic sling to treat stress urinary incontinence (SUI), newer approaches, different techniques and new devices have been created. Transobturator and single-incision sling (SIS) techniquespara-were developed with the goal of diminishing the rate of complications andspeeding the recovery phase. Methods: For this review we searched Medline for relevant papers, with an emphasis on meta-analysis and randomised controlled trials (RCTs). Specially selected reports were identified to address both ’index patients’ (defined as those with genuine SUI and no previous anti-incontinence procedure or other genitourinary sign or symptom that might affect her SUI) and, briefly, non-index patients. Two authors independently reviewed papers for eligibility. Results: Level 1 evidence from a Cochrane review and two meta-analyses indicated that subjective outcomes with the mid-urethral sling (MUS) were similar to those from colposuspension. However, the MUS was better than colposuspension when assessing objective outcomes (Level 1). MUS are equally effective as autologous pubovaginal slings (Level1). Two meta-analyses suggest that retropubic MUS (RMUS) might be better than transobturator MUS when assessing objective outcomes. Five more recent RCTs with longer term outcomes showed high success rates and only one reported a significant advantage for the RMUS in women with intrinsic sphincteric deficiency. One meta-analysis addressing the SIS showed inferior outcomes to the MUS (Level 1). New and improved SIS techniques have been used, but long-term outcomes are limited and results are still controversial when compared to the MUS. Conclusion: MUS are still the standard to treat the index patient as previously stated by the American and European Associations of Urology. Currently data are lacking to define which sling and what approach works best. Complications are significantly different between sling types and are dependent on technique. [Copyright &y& Elsevier]

The objective of this study was to assess the impact of body mass index (BMI) on transobturator tape (TOT) success rates, patient acceptability and complications 1 year following surgery. The medical records of stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) patients who underwent the TOT operation were retrospectively reviewed. The patients were divided into non-obese (BMI < 25) and obese (BMI ≥ 30) groups. Baseline and 1 year post-surgical outcomes were assessed by including multichannel urodynamics, Urogenital Distress Inventory (UDI-6) scores, Incontinence Impact Questionnaire (IIQ-7) scores and cure, failure and success rates. There were no significant differences between groups in terms of urodynamic parameters, objective cure rate and subjective success, quality of life scores, or postoperative complications. Both obese and non-obese patients had cure and/or improvement of their symptoms and had better quality-of-life in the postoperative period. As a conclusion, BMI does not affect the clinical effectiveness of TOT operation in the treatment of female SUI or MUI. [ABSTRACT FROM AUTHOR]