Urinary stress incontinence

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Abstract
New minimal access surgical sling procedures such as the tension-free vaginal tape procedure are now being used to treat urinary stress incontinence in women. These procedures use minimal tension—urethral support is perhaps achieved from a tissue reaction to the tape, which produces a collagen scar along the length of the tape and increases support of the bladder when the rectus muscle contracts. The tension-free vaginal tape procedure is often carried out under regional or local anaesthesia. Many women would undoubtedly welcome the choice of a less invasive procedure than open retropubic colposuspension—as long as the minimal procedure cures urinary incontinence and does not result in major complications. What does the currently available evidence say? Two recent systematic reviews concluded that, although the minimal access surgical sling procedures (and particularly tension-free vaginal tape) may be promising, the quality of the evidence available so far is not conclusive. 1 2 So far almost all the evidence has come from case series. So the six month results for the first multicentre randomised trial of tension-free vaginal tape have been eagerly awaited,3 since only preliminary results could be included in these systematic reviews. Ward et al concluded that in their trial …