Stress urinary incontinence: the evolution of the sling

Stress urinary incontinence is one of the most prevalent and costly problems encountered by the international medical community. The exact mechanism of stress incontinence remains elusive. Early management relied on behavioral modification but, as more advanced anatomic and urodynamic research surfaced, the focus shifted to surgical correction. Initial innovations provided a compressive force/hammock to support the urethra and bladder neck. For almost a century, the pubovaginal sling provided this support, with 70-90% cure rates at the expense of significant voiding dysfunction. Later work has highlighted the interaction of muscles and ligaments as a midurethral kinking mechanism to prevent leakage. With this knowledge came the advent of tension-free vaginal taping. Further modifications led to the development of other midurethral slings, producing similar cure rates while minimizing complications.