New millennium, new slings

The etiology of stress incontinence is not completely understood. In the past, bladder neck suspensions were performed to correct anatomic abnormalities of the bladder neck and urethral hypermobility. This procedure was attractive because of its simplicity, low morbidity, and excellent early success rate. With time, the successes seen with bladder neck suspensions have not proven to be durable, and alternative surgical procedures have been developed. Until recently, the indications for bladder neck suspension were types I and II stress incontinence; slings were reserved for type III incontinence. However, slings have been shown to be as effective as and more durable than bladder neck suspensions for treatment of all types of stress incontinence; therefore, their popularity has spread. The success of distal urethral slings suggests that it is not necessary to correct anatomic hypermobility to correct stress incontinence. A plethora of new procedures and materials has emerged, leading to an increased need for well-controlled, objective outcome studies in order to understand the impact of these surgeries on our patients.