Single-incision Midurethral Sling Research Articles

Randomized Trial of Single-Incision Midurethral Sling and Laparoscopic Burch Colposuspension: Postoperative Surgical Outcomes and Complications

Various retropubic and midurethral sling techniques have shown high cure rates in the treatment of stress urinary incontinence (SUI). This study aimed to compare single-incision midurethral sling (SIMS) and laparoscopic Burch colposuspension (LBC) procedures in patients with SUI in terms of the effectiveness, patient satisfaction, surgical complications and results. This is a prospective randomized study. A university tertiary hospital. Forty patients with clinically and/or urodynamically proven SUI who agreed to surgical treatment were randomized to the SIMS and LBC groups and included in the study. Patients were treated with SIMS and LBC operations. Demographic characteristics of patients, physical and pelvic examination, preoperative and postoperative clinical findings, Kings Health Questionnaire form, Female Sexual Function Index and Prolapse Quality of Life Questionnaire form, postoperative day 1 visual analog scale score, and postoperative complications were recorded. Objective and subjective success rates were recorded by re-evaluating the patients in the first and sixth months of the operation. Objective success was defined as having a negative stress test and subjective success was defined as the absence of stress-induced urine leakage after surgery in a validated questionnaire. The primary result of our study was considered to be objective success, whereas the secondary result was subjective success and life quality tests. Twenty patients each in the SIMS group and the LBC group were included in the study. No significant difference was found in objective success (90% vs 85%, p = .633) or subjective success (85% vs 75%, p = .695) between the 2 groups at 6-month follow-up. A significant improvement in life quality was observed in the postoperative period for both groups; however, the difference between the groups was not significant. There was an improvement in sexual function in both groups. Nonetheless, although this improvement was significant in the SIMS group, it was not significant in the LBC group. In addition, surgery time, catheterization time, and hospitalization time were shorter in the SIMS group than in the LBC group. The visual analog scale score on postoperative day 1 was lower in the SIMS group. Groups were not different in terms of preoperative and postoperative complications. This preliminary study is the first randomized study that compares the LBC and SIMS procedures in the literature. It shows that SIMS and LBC procedures have not different objective and subjective success rates in the short term. It was also observed that they increase both sexual and life quality results in a positive and similar way.

Retropubic versus single-incision mid-urethral sling for concomitant management of stress urinary incontinence during native tissue vaginal repair: a randomized clinical trial

Retropubic versus single-incision mid-urethral sling for concomitant management of stress urinary incontinence during native tissue vaginal repair: a randomized clinical trial

Three-year Follow-up of a Single Incision Sling Procedure Performed Under Local Anesthesia in an Office Setting

To assess the 3-year success of placing a single-incision midurethral sling (SIMS) using the Dynamic Intraoperative Standing Sling Technique (DISST) in an office setting under local anesthesia. This is a prospective case series of 20 women who underwent in-office SIMS procedure by the DISST from July 2019 to February 2020. This is an extension of our pilot study (11) and all 20 patients were evaluated at a mean follow-up of 34.3months. Success was defined as a composite score of objective success (negative standing cough test at bladder fullness), subjective success based on the modified PGI-I score of "very much better" or "much better," and no retreatment for stress urinary incontinence. Secondary objectives were adverse events, de novo overactivity of the bladder, recurrent urinary tract infections, voiding dysfunction, pain/dyspareunia, and influence on sexual function. The composite success rate was 95% (95% CI [75.1, 99.9]) at the 36-month follow-up. The significant improvement in MESA scores was maintained over the study period. There were no cases of de novo urgency, mesh exposure, postop voiding dysfunction or recurrent urinary tract infections. There were no cases of de novo dyspareunia. SIMS placed by the DISST technique under local anesthesia in an office setting has shown sustained efficacy over a 3-year period with no decrease in cure. Subjects remained dry and reported excellent improvement in symptoms and quality of life at the 36-month follow-up visit.

Single Incision Midurethral Sling Site of Care: Office-based Ambulatory Surgical Unit versus Hosptial-based Ambulatory Surgical Unit Setting

To compare the economic difference in terms of overall costs between two Ambulatory Surgical Unit (ASU) settings in which a midurethral single incision sling (MSIS) can be performed. A retrospective cohort study was carried out, examining the implanting of an MSIS performed at two different ASU settings by a single surgeon. Total cost was determined by assessing differences in charges and subsequent reimbursement associated with the procedure at each ASU setting. Time was measured using an EMR system for tracking both patient entry/exit from the facility as well as intraoperative time. Adverse events commonly associated with the procedure and patient-reported unanticipated adverse events were collected. A validated Surgical Satisfaction Questionnaire was administered postoperatively. University Health Network Teaching Hospital. A total of 125 women with stress urinary incontinence. MSIS. Between January 2016 until August 2020, 125 women underwent an MSIS procedure. The total office-based ASU (O-ASU) charges averaged $4564.00 (reimbursement of $2642.07). The total hospital-based ASU (H-ASU) charges averaged $40 136 (reimbursement of $9000), as well as an anesthesia average charge of $800 (reimbursement of $500). The average O-ASU total patient encounter time was 53.76 minutes versus 344.702 minutes for the H-ASU. There was no difference between commonly associated or unanticipated adverse events nor global patient satisfaction. Based on overall cost, total encounter time, and global patient satisfaction, a certified O-ASU is an optimal site of care for MSIS for surgical management of female stress urinary incontinence.

Comparing Single-Incision Midurethral Sling with Bulking Agents for Female Stress Urinary Incontinence: Rationale for a Non-Randomized Controlled Trial

Objectives: Midurethral slings are considered the gold standard for the surgical treatment of stress urinary incontinence (SUI), with an efficacy up to 80%. Another therapeutic option is the use of bulking agents, which create an artificial mass in the urethral submucosa, with an efficacy varying from 64% to 74%. Although bulking agents have a lower risk of complications than midurethral sling surgery, they are mainly used in case a midurethral sling is not an option or if midurethral sling surgery failed to cure stress urinary incontinence. In this study, we offer all patients with SUI in secondary care a choice between a single-incision midurethral sling procedure and treatment with a bulking agent. We want to examine patient preference and patient satisfaction for both procedures. We expect that offering both interventions in combination with standardized counselling will result in high patient satisfaction. Design: In this non-randomized controlled trial, 266 patients will be objectively counselled for both interventions, after which all patients will choose between single-incision midurethral slings and polyacrylamide hydrogel (PAHG), followed by the standard care procedure for women with SUI. Participants/Materials, Setting, Methods: From January 1, 2021, onward, all consecutive adult patients (between 18 and 80 years of age) attending the outpatient gynaecology department with objectively confirmed, moderate to severe SUI will be eligible for enrolment in this non-randomized study. The primary outcome is patient satisfaction at 1 year, measured by the Patient Global Impression of Improvement; secondary outcomes are patient satisfaction at 3 months, objective and subjective cure at 3 months and 1 year, adverse events, post-operative pain, and cost-effectiveness. Differences in outcome measures will be assessed through logistic and linear regression analyses, both unadjusted and adjusted with covariate adjustment using the propensity score. Results: No results are available yet. Limitations: The major disadvantage of this study design is the potential confounding bias. We intend to eliminate this bias by applying propensity scoring. Conclusion: By designing a non-randomized patient preference trial, we not only expect to demonstrate high patient satisfaction with both interventions but also provide insight into the possible role of PAHG-injections in the treatment of female SUI as a first-choice non-conservative treatment.

Cost Value Analysis of Single Incision Midurethral Sling Insertion in the In Office Vs. Hospital Setting

<h3>Study Objective</h3> Patient outcomes between Mid-urethral slings in office setting vs hospital setting based on average total patient encounter time, total procedure time, total patient cost. The secondary outcomes were adverse events, unexpected outcomes, and urgent evaluation. <h3>Design</h3> Retrospective, double-arm study, 1 physician implanted a mid-urethral single-incision sling with the clinical diagnosis for urethral hypermobility or stress urinary incontinence. <h3>Setting</h3> Office setting and hospital-based setting. <h3>Patients or Participants</h3> 78 women underwent sling placement in an office setting and 47 patients underwent sling placement in a hospital-based setting. <h3>Interventions</h3> Patients were evaluated at 2 and 6 weeks after surgery. A validated Surgical Satisfaction Questionnaire (SSQ-8) was collected at the 6-week post-operative visit. Patients that did not complete the SSQ-8 were contacted by phone. All women with the diagnosis of urethral hypermobility or stress urinary incontinence. <h3>Measurements and Main Results</h3> Between January 2016 until August 2020 a total of 125 women underwent a single incision mid urethral sling procedure. Hospital-based setting: The average SSQ-8 score totaled 39.17 out of 40. The average total patient encounter time was 344.702 minutes. The average total time in the OR was 50.06 minutes. 5 total patients reported one adverse event, 13 patients reported 6 unexpected outcomes. No patients were seen for emergent evaluation. Office-based setting: The average SSQ-8 score totaled 39.48 out of 40. The average total patient encounter time was 53.76 minutes. The average total time in the OR was 22.05 minutes. 5 total patients reported one adverse event, 25 patients reported 27 unexpected outcomes. 1 patient was seen for emergent evaluation. No statistically significant differences in patient satisfaction. <h3>Conclusion</h3> The findings have shown considerable favor office-based setting in comparison to the hospital setting. There is a significant difference in the financial cost and the total patient encounter time. The office-based setting would be the more advantageous option for patients. The office-based setting is cost-effective, less time-consuming, and is safe.

Single-incision Midurethral Sling by the Dynamic Intraoperative Standing Sling Technique as an Office-based Procedure: A Pilot Study

ObjectivesTo assess the safety, feasibility, and short-term success of placing Solyx (Boston Scientific, Marlborough, MA) single-incision midurethral sling (SIMUS) using the Dynamic Intraoperative Standing Sling Technique (DISST) in an office setting under local anesthesia. MethodsThe safety and efficacy of the in-office Solyx DISST procedure for treatment of stress urinary incontinence was assessed 6 months from the procedure. Improvement in stress urinary incontinence was measured using validated questionnaires (Medical, Epidemiologic, and Social Aspects of Aging, MESA; Incontinence Impact Questionnaire-7, IIQ-7; Pelvic Organ Prolapse/Urinary Incontinence Sexual Function, PISQ-12) and by a negative standing provocative stress test. Postoperative complications were documented along with subjective pain diaries, return to work/activities, and overall satisfaction. ResultsFrom July 2019 through February 2020, 20 subjects underwent in-office Solyx procedure by the DISST technique. Six of the 20 (30%) subjects required intraoperative sling adjustments. There were no complications as related to the office-based procedure. Participants reported a favorable intraoperative experience. Subjects had excellent postoperative pain control and early return to work and normal activities. At 6 months, all 20 subjects had negative standing provocative stress tests, showed statistically significant improvements on MESA, IIQ-7, and PISQ-12, and reported high satisfaction and acceptance for the procedure and outcomes. There were no late (>6 weeks) complications associated with the Solyx procedure. ConclusionsIt appears safe and feasible to perform Solyx SIMUS by the DISST method in the office. Subjects remained dry and reported excellent improvement in symptoms and quality of life 6 months from surgery.

Single Incision Sling Procedure Done by the Dynamic Intraoperative Standing Sling Technique: A 2-Year Analysis

Objective: To evaluate 2-year outcome of subjects who underwent the single incision midurethral sling procedure by the Dynamic Intraoperative Standing Sling Technique (DISST). Design: A chart revie...

Single-incision midurethral sling shows less pain and similar success rate in a short-term follow-up compared to the transobturator tape method in the treatment of stress urinary incontinence.

To compare the efficacy, complications, quality of life, and patient satisfaction rates in women treated for stress urinary incontinence (SUI) using the adjustable anchored single-incision midurethral sling (SIMS) and standard midurethral sling (MUS) procedures. A total of 113 women between October 2012 and October 2016 underwent either the adjustable SIMS (n=54) or MUS (n=57) procedure. The postoperative pain profile was assessed using a 10-point visual analog scale at the fixed time-point quality of life and an additional postoperative 3rd week appointment. We asked our patients the following two questions to evaluate their satisfaction with surgery and their preference: "Would you have this kind of surgery again?" (Q1), and "Would you recommend this type of surgery to another patient with same symptoms?" (Q2). For the evaluation of patient complaints, the Incontinence Impact Questionnaire (IIQ-7) and Urinary Distress Inventory (UDI-6) were used before and after the procedure. Women in the SIMS group had a significantly lower postoperative pain profile for up to 3 weeks (p<0.001). There was no significant difference in perioperative complications and postoperative continence rates between the groups. With regard to Q1 and Q2, a significant difference was found between the groups (p=0.003 and p=0.002, respectively). While the questionnaire scores of the IIQ-7 and UDI-6 were also significantly improved at postoperative evaluations (p<0.001), there was no significant difference between the two groups. SIMS is associated with a significantly improved postoperative pain profile and earlier return to work when compared to MUS.

Osteochondroma of the Pubic Symphysis Involved With Aberrantly Placed Minisling: A Case Report

Osteochondromas are benign bone tumors that rarely involve the pubic symphysis. This case report describes a 41-year-old woman with a pubic symphyseal osteochondroma associated with an aberrantly placed single incision sling. After an outside surgeon placed a single incision midurethral sling for stress urinary incontinence, she developed pelvic pain, dyspareunia and vaginal mesh sling exposure. Imaging demonstrated a 2.6 centimeter calcified mass posterior to the pubic symphysis. The patient underwent excision of the mass and the eroded mesh sling via vaginal and abdominal approaches. Pathology demonstrated osteochondroma aggregated around mesh. This is a rare case of a single incision sling placed aberrantly into a pubic symphyseal osteochondroma that required excision.

Surgery for Stress Incontinence – A Novel “Needleless” Single-Incision Sling System: Results of 50 Patients

To evaluate the safety and efficacy of a single incision mid-urethral sling which requires no retro-pubic or groin needle passage for the treatment of female stress urinary incontinence(SUI).

Are patients willing to trade cure rate against less pain? Patients’ preferences for single incision midurethral sling or transobturator standard midurethral sling

To quantify to what extent patients are willing to trade their chance of cure of stress urinary incontinence (SUI) against less postoperative groin pain. Randomized, controlled trials show less postoperative pain following single-incision mini-sling (SIMS), but slightly higher cure rates following a transobturator standard midurethral sling (SMUS). A multi-center, interview-based trade-off experiment for treatment preference among 100 women with predominant SUI and undergoing SIMS. A hypothetical cure rate of SIMS was systematically varied from 10% to 70%, while keeping the cure rate of SMUS constant at 70%. The trade-off was assessed for two hypothetical durations of substantial postoperative pain after SMUS-2 days or 2 weeks-while simultaneously assuming the absence of substantial postoperative pain after SIMS. To prevent 2 days of substantial postoperative pain with SMUS, patients were willing to accept a 4.3% mean decrease in cure rate of SIMS, while a 7.1% mean decrease was acceptable to forego 2 weeks of substantial pain. Younger women (P = 0.04) and single women (P = 0.04) were associated with the trade-off limit for 2 days, respectively, 2 weeks of substantial postoperative pain. Single women were willing to accept lower cure rates. No correlations with trade-off limits were found for patients' actual severity, duration, and frequency of SUI. Patients are willing to accept a slightly lower probability of cure to prevent substantial post-operative pain by undergoing a less invasive procedure. These results are relevant for counselling of patients indicated for SUI surgery.

Is single incision midurethral sling effective in patients with low maximal urethral closure pressure?

ObjectiveTo ascertain whether low preoperational maximal urethral closure pressure (MUCP) affects the outcomes of single incision sling (SIS) procedures and changes MUCP values postsurgery. Material and methodsThere were 112 (MUCP ≥ 40 cmH2O, n = 88; MUCP < 40 cmH2O, n = 24) consecutive women with urodynamic stress incontinence who had undergone SIS (MiniArc) procedures included in this study. The threshold of 40 cmH2O was used since it has been shown to be a significant risk factor for failed incontinence surgery. Clinical outcomes were assessed by the cough stress test, the 1-hour pad test, the Incontinence Impact Questionnaire-Short Form, the Urogenital Distress Inventory six-item questionnaire, the Sexual Questionnaire-SF, and postoperative changes in the urodynamic parameters. A comparison of the 1-year follow-up data is presented. ResultsThree months postsurgery, a significant decrease was observed in the 1-hour pad test, from 20.6 g preoperatively to 0.73 g postoperatively (p < 0.001). The objective cure rate was 82.1% without any significant differences between the two groups (p = 0.202). At 3 months and 1 year after surgery, significantly decreasing Urogenital Distress Inventory six-item questionnaire and Incontinence Impact Questionnaire-Short Form, and increasing Sexual Questionnaire-SF scores were observed in both groups, without any significant differences between the two groups. No statistically significant difference in the subjective cured rate was noted between the two groups at the 3-month and 18.4 month follow-ups. The postoperative MUCP was significantly decreased in the MUCP ≥ 40 group (p < 0.05) while significantly increased in the MUCP < 40 group (p = 0.006). ConclusionsThese results suggest that SIS is a safe and highly effective treatment for urodynamic stress incontinence even in women with low MUCP at a mean follow-up of 18.4 months. Evaluation of the outcomes with more subjects after a longer follow-up period is necessary.

The Effect of Valsalva Leak Point Pressure on Outcomes of the Needleless ®System in Female Stress Urinary Incontinence.

This study aimed to investigate the effects of preoperative Valsalva leak point pressure (VLPP) on the outcomes of the single-incision midurethral sling procedure (Needleless® System) in female stress urinary incon­tinence (SUI). We evaluated 112 patients who underwent midurethral sling placement for SUI using the Needleless® System. Patients were divided into two groups according to their preoperative VLPP values: VLPP >90 cmH2O (group 1) and VLPP 60-90 cmH2O (group 2). After the postoperative period, SUI status and satisfac­tion were compared between the two groups. Subjective cure was defined as the absence of any episodes of urinary incontinence associated with conditions that increase intra-abdominal pressure in daily life. Treatment satisfaction was analyzed according to patient responses as 'satisfied', 'neutral', and 'dissatisfied'. Postoperative other lower urinary tract symptoms except SUI were compared between the two groups too. There were no significant differences in age, body weight, and urodynamic parameters (except VLPP) between the two groups. The mean VLPPs were 105.9 ± 12.3 cmH2O (range, 93.6-118.2 cmH2O) in group 1 and 75.4 ± 10.5 cmH2O (range, 65-85.9 cmH2O) in group 2. The overall subjective cure rates were 65.0% in group 1 and 62.5% in group 2 (P = .744). The overall satisfaction rates were 58.8% in group 1 and 68.8% in group 2 (P = .600). Complication rates did not differ between the two groups. When stratified as > 90 cmH2O or ≤ 90 cmH2O, preoperative VLPP did not affect Needleless® Sys­tem outcomes in female SUI patients.

Primary experiences of single incision midurethral sling in women with stress urinary incontinence

Primary experiences of single incision midurethral sling in women with stress urinary incontinence

12 Surgical treatment of stress urinary incontinence and anterior vaginal wall prolapse with a transobturator tape after failure of single-incision mid-urethral sling

12 Surgical treatment of stress urinary incontinence and anterior vaginal wall prolapse with a transobturator tape after failure of single-incision mid-urethral sling

A Randomized Comparison of Single Incision Mid-urethral Sling (MINIARCTM) and Transobturator Mid-urethral Sling (MONARCTM) for Treatment of Stress Urinary Incontinence: 2-Year Clinical Outcomes

A Randomized Comparison of Single Incision Mid-urethral Sling (MINIARCTM) and Transobturator Mid-urethral Sling (MONARCTM) for Treatment of Stress Urinary Incontinence: 2-Year Clinical Outcomes

A Randomized Comparison of a Single-incision Midurethral Sling and a Transobturator Midurethral Sling in Women with Stress Urinary Incontinence: Results of 12-mo Follow-up

BackgroundMidurethral sling procedures have become the prime surgical treatment for women with stress urinary incontinence (SUI). Single-incision mini-slings (SIMS) potentially offer similar efficacy with reduced morbidity. This international multicenter trial compared the efficacy and morbidity of a SIMS (MiniArc) and a transobturator standard midurethral sling (SMUS) (Monarc). ObjectiveTo compare subjective and objective cure, morbidity, and surgery-related discomfort following SIMS and transobturator SMUS. Design, setting, and participantsProspective randomized controlled trial with an initial follow-up period of 12 mo. Women with symptomatic SUI were eligible. Outcome measurements and statistical analysisPrimary outcome was subjective cure, defined as an improvement on the Patient Global Impression of Improvement (PGI-I). Coprimary outcome was the mean visual analog scale (VAS) pain score (0–100) during 3 d after surgery. Secondary outcomes were objective cure based on the cough stress test (CST), disease-specific quality of life determined by the Urogenital Distress Inventory (UDI-6) score, surgical parameters, and physical performance during recovery. Analysis was by intent to treat. Differences between the MiniArc and Monarc groups on dichotomous variables were chi-square tested and presented as relative risks (RR) with corresponding 95% confidence intervals. We hypothesized that MiniArc was noninferior to Monarc concerning subjective cure and superior concerning postoperative pain. Results and limitationsWe randomized 97 women to MiniArc and 96 to Monarc. At 12-mo follow-up, subjective cure was 83% following MiniArc and 86% following Monarc (p=0.46). Objective cure was 89% following MiniArc and 91% following Monarc (p=0.65). The mean pain VAS score during the first three postoperative days was 9 following MiniArc and 22 following Monarc (Mann-Whitney U test, p<0.01). ConclusionsAt 1-yr follow-up, MiniArc was noninferior to Monarc with respect to subjective and objective cure and superior with respect to postoperative pain. Patient summaryThis 1-yr randomized clinical trial showed that MiniArc, a single-incision midurethral sling, is noninferior to Monarc, a transobturator sling, with respect to cure and superior with respect to pain and recovery.

Changes in sexual function and quality of life after single-incision mid-urethral sling for treatment of female stress urinary incontinence

ObjectivesTo evaluate the effectiveness and assess the changes in sexual function and quality of life after placement of a single-incision sling for the treatment of female stress urinary incontinence. Study designA prospective study of women diagnosed with stress urinary incontinence. The single-incision sling was implanted and patients were followed postoperatively for 6 months. The postoperative rate of continence, complications, changes in sexual function, and patient-reported quality of life were evaluated. Female Sexual Function in sexually active patients was evaluated before and after the single-incision sling procedure using the Female Sexual Function Index. From January 2009 to November 2011, 73 patients were enrolled and underwent the procedure to implant the MiniArc® or Ajust® single-incision sling. ResultsOverall, 93.2% of the patients who successfully received a single-incision sling demonstrated total restoration of continence (83.6%) or improved continence (9.6%) at the 6-month postoperative visit. Improvements were seen in the quality of life scores related to global bladder feeling (87.7%) and the Female Sexual Function Index (preoperative score 23.86±5.67 vs postoperative score 27.25±4.66 [P<0.0001]). ConclusionSingle-incision sling treatment for stress urinary incontinence led to improvements in continence and sexual function at 6 months of postoperative follow-up.

The Comparison of Short Term Results ofTransobturatour Tape and Single Incision MidurethralSling Procedures

www.SID.ir Int J Women’s Health Reproduction Sci Vol. 1, No. 3, Autumn 2013 ISSN 2330-4456 The Comparison of Short Term Results of Transobturatour Tape and Single Incision Midurethral Sling Procedures Mehmet Bilgehan Yuksel1, Osman Kose2* , Ayhan Karakose3, Sacit Nuri Gorgel2, Yuksel Yilmaz2, Bilal Gumus1 Abstract Objectives: We aimed to evaluate the efficacy of transobturator tape (TOT) and single incision mini sling (SIMS) procedures in the treatment of stress urinary incontinence (SUI). Materials and Methods: The data of 32 patients who underwent TOT(Promedon®) or SIMS (Ophira®) operations related to SUI between January 2010 August 2012 were retrospectively evaluated. The sample divided in two groups according to the operation type. The demographical features, preoperative, perioperative, and postoperative data were analysed and compared between two groups to evaluate the efficacy of the operations in SUI. All patients were assessed with a detailed history, physcical examination, cough test, Q-tip test, ultrasonography, postvoiding residual measurement, cystometry and UDI-6, IIQ-7 questionares. Postoperatively, the patients without any incontinence on cough test or sistometry were defined as the success. Results: The parameters of age, menapousal status, number of vaginal delivery, and body mass index were similar in two groups. The mean operation time was significantly shorter in SIMS group (16±3 vs 27±5, p 0.05). Postoperative UDI-6 and IIQ-7 scores were 3.5 ± 3.4 vs 3.8 ± 4.8 and 4.4 ± 4.2 vs 5.1 ± 5,6 respectively, and they were similar (p>0.05 in both). In addition, the improvement in these scores were not statistically significant between two groups (p>0.05 in both). Conclusion: SIMS procedure is safe and as effective as TOT with shorter operation time in the surgical teratment of female SUI. 1Celal Bayar University, Faculty of Medicine, Department of Urology, Manisa, Turkey. 2-Katip Celebi University, Ataturk Training and Research Hospital, Department of Urology. Izmir, Turkey 3-Izmir University, School of Medicine, Department of Urology, Izmir, Turkey Article History: Received July 2013 Accepted September 2013 Available online September 2013 Corresponding Author: Osman Kose, Katip Celebi University, Ataturk Training and Research Hospital, Department of Urology, Izmir/ Turkey. Tel: +905306966022 Email: oskose@gmail.com