EURURO Vol. 72 No. 4

Platinum Priority – Editorial

Referring to the article published on pp. 567–591 of this issue

Surgical Treatment of Female Stress Urinary Incontinence:

Do Tapes Stand the Test of Time?

Frank Van der Aa

a , c

[1_TD$DIFF]

, * ,

Jan Deprest

b , c

[2_TD$DIFF]

Dirk De Ridder

[3_TD$DIFF]

, c

Clinical Department of Urology, University Hospitals Leuven, Leuven, Belgium;

Department of Obstetrics and Gynaecology, University Hospitals Leuven,

Leuven, Belgium;

Academic Department of Development and Regeneration, KU Leuven, Leuven, Belgium

The lifetime risk of undergoing surgery for stress urinary

incontinence (SUI) among women in developed countries

varies between 6.6% and 13.9%, depending on location and

time period

[1,2]

. The annual risk starts to increase between

the third and fourth decade of life, and peaks in a bimodal

curve at 46 yr and 70–71 yr

[1] .

The majority of procedures

are performed in otherwise healthy subjects who want to

regain their quality of life. Although the majority of women

are willing to undergo surgery to solve their problem, this

type of functional surgery must be effective and safe to be

justified

[3]

. More importantly, it must stand the test of

time, as many women will live an active life for many years

after the surgery. The long-term effects of sling surgery are

still largely unknown. In this issue of

European Urology

, the

meta-analysis by Fusco et al

[4]

includes nine randomised

clinical trials with follow-up of more than 60 mo. Appar-

ently, the favourable outcomes do not change significantly

over time. This conclusion has to be tempered, given that

the underlying data are based on low numbers (limited

statistical power) and low study quality (high attrition

rates). Adequate long-term reporting including survival

analysis is almost completely lacking in this field. Therefore,

well-designed prospective registries should be initiated to

dures. Registration will most probably be implemented all

over Europe in the near future, according to recommenda-

tions by the EU Scientific Committee on Emerging and

Newly Identified Health Risks

[5]

, but results will not be

available for a long time to come.

Since the introduction of mid-urethral slings (MUS)

around 1999, the absolute number of SUI surgeries has

increased. MUS placement has progressively replaced the

majority of other SUI procedures, almost abolishing primary

colposuspension and pubovaginal slings in some countries

[6] .

This is in accordance with current knowledge and

guidelines

[7] .

Fusco et al

[4]

reconfirm the superiority of

MUS over Burch colposuspension, even in the long run.

Pubovaginal slings might be equally effective as MUS, but

are associated with significantly higher storage lower

urinary tract symptoms

[4]

. MUS placement is now the

best studied and documented approach for female SUI

surgery

[8]

. As a primary procedure, MUS placement should

therefore be offered as a first choice to the patient. On the

basis of the literature, physicians can discuss the different

routes with their patients in terms of efficacy and safety. If

MUS cannot be considered, pubovaginal slings offer an

effective alternative

[7] .

Burch colposuspension is less

effective and should probably only be performed in the

salvage setting or in adjunct with other surgery, or in cases

in which the patient does not want to have synthetic tapes

implanted

[9]

In the current era of mesh issues, it is important to stress

that synthetic MUS

[4_TD$DIFF]

offers, to the best of our knowledge, a

safe and effective solution for female SUI. The short- and

medium-term complication rates are well known and

adequately reported

[8]

. Complications with tapes are

usually easier to manage than those arising from vaginal

mesh for prolapse. We believe that the debate on

transvaginal mesh for prolapse should not contaminate

this discussion or change our clinical practice because of

potential graft-related complications associated with the

use of mesh. Given that the surface area of the implanted

E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 5 9 2 – 5 9 3

available at

www.scienced irect.com

journal homepage:

www.europeanurology.com

DOI of original article:

http://dx.doi.org/10.1016/j.eururo.2017.04.026

* Corresponding author. Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. Tel. +32 16 346930;

Fax: +32 16 346931.

E-mail address:

frank.vanderaa@uzleuven.be

(F. Van der Aa).

http://dx.doi.org/10.1016/j.eururo.2017.05.013

0302-2838/