Comment on Tsivian et al.: Redo midurethral synthetic sling for female stress urinary incontinence

Abstract

Dear Editor, Tsivian et al. report their experience with repeat midurethral synthetic slings, for which they deserve to be congratulated. In the literature and at pelvic surgery conferences, the issue of failed slings is fairly common. Most if not all, the reports are empirical rather than evidence based, which is quite understandable considering the rapid emergence of this technology with numerous types of sling materials and many competing manufacturers. Few of the reports image the unsuccessful sling. Reports of transvaginal ultrasound images can reveal whether the sling is too tight, too loose, or has migrated proximally or distally. It is very possible that, as this form of imaging becomes commonplace, the information gathered may contribute to improved technique and decipher superior sling materials. One modification to performing midurethral slings to consider is using a transverse incision rather than the standard longitudinal incision. This would have a much greater chance of preventing sling migration. The objection to a transverse incision is that this could have a higher incidence of vaginal erosion. However, this is only conjecture. With time, and better reporting and regulations, patients should experience better results with lower complications. In addition to accurate registries of all types of slings, physician report cards could be created to upgrade the performance of the low performers and make mentors of the highest performers to improve overall results. Int Urogynecol J (2007) 18:839 DOI 10.1007/s00192-007-0335-7