Synthetic slings: which material, which approach.

Objective: The success in the use of the tension-free midurethral sling procedures (tension-free vaginal tape, suprapubic arch, transobturator tape) has dramatically altered the approach to the surgical management of stress urinary incontinence in women and marked a resurgence in the use of mesh. We will analyze the characteristics of synthetic meshes and explain the rationale for using monofilament materials with larger pore sizes. Thus, the purpose of this review is to introduce the surgeon to a variety of commercially available mesh materials and the characteristics that make mesh suitable for use as sling grafts.

Results: Type I macroporous mesh materials appear most suitable for transvaginal implantation. Utilization of these materials in a minimally invasive retropubic or transobturator approach, promising early and intermediate follow-up data has been achieved. The outcome of these procedures in women with urethral hypermobility and genuine stress incontinence seems clear. No controlled data, however, exist to define the role of these procedures in difficult cases of stress incontinence. Newer generations of minimally invasive slings may offer treatment alternatives in these difficult cases.

Conclusions: Minimally invasive slings using Type I mesh materials are safe and effective. 'Hybrid' type slings may offer alternatives in difficult cases of stress urinary incontinence.