Surgical treatment of the female stress urinary incontinence – from needles to mini-slings

Authors: M. Juráková 1,2;  M. Huser 2;  O. Szabová 1;  I. Belkov 2;  P. Ventruba 2;  P. Vašek 1
Authors‘ workplace: Gynekologicko-porodnická klinika OU a FN, Ostrava, přednosta doc. MUDr. O. Šimetka, Ph. D., MBA 1;  Gynekologicko-porodnická klinika MU a FN, Brno, přednosta prof. MUDr. P. Ventruba, DrSc., MBA 2
Published in: Ceska Gynekol 2017; 82(1): 65-71


Stress urinary incontinence (SUI) is a clinical problem affecting a large part of female population, its incidence increases with age. Aim of this article is to show the spectrum of surgical procedures which are used to treat SUI, their advantages and limits, and define suitable patients.

Review article.

Department of Gynecology and Obstetrics LF OU and University Hospital Ostrava; Department of Gynecology and Obstetrics LF MU and University Hospital Brno.

Systematic literature review using keywords and Medline database with detailed survey results analysis – full-text papers or abstracts published in years 1966–2016.

Historical and recent methods of SUI testament are summarized including its effectiveness and complications focused mainly on techniques developed in the last two decades.

There is a wide spectrum of surgical techniques available for SUI treatment for women and in last twenty years the procedures improved significantly regarding its effectiveness and complication rate. This paper review and summarize these methods, its efficacy, recent indications, advantages and limits. Although none of those techniques is perfect, patients treated by experienced surgeons have significant chance in quality of live improvement.

stress urinary incontinence, surgical treatment, tape procedures, bulking agents


1. Abrams, P., Cardozo, L., Fall, M., et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology, 2003, 61(1), p. 37–49.

2. Agur, W., Riad, M., Secco, S., et al. Surgical treatment of recurrent stress urinary incontinence in women: a systematic review and meta-analysis of randomised controlled trials. Eur Urol, 2013, 64(2), p. 323–336.

3. Alcalay, M., Monga, A., Stanton, SL. Burch colposuspension: a 10-20 year follow up. Br J Obstet Gynaecol, 1995, 102(9), p. 740–745.

4. Berkow, SG. The corpus spongeosum of the urethra: Its possible role in urinary control and stress incontinence in women. Am J Obstet Gynecol, 1953, 65, p. 346–351.

5. Blaganje, M., Lukanović, A. Intrasphincteric autologous myoblast injections with electrical stimulation for stress urinary incontinence. Inter J Gynecol Obstet, 2012, 117(2), p. 164–167.

6. Burch, JC. Urethrovaginal fixation to Cooper’s ligament for correction of stress incontinence, cystocele, and prolapse. Am J Obstet Gynecol, 1961, 81, p. 281–290.

7. Cornella, JL. Management of stress urinary incontinence. Rev Urol, 2004, 6(5), p. 18–25.

8. DeLancey, JO. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol, 1994, 170(6), p. 1713–1723.

9. Feyereisl, J., Dreher, E., Haenggi, W., et al. Long-term results after Burch colposuspension. Am J Obstet Gynecol, 1994, 171(3), p. 647–652.

10. Haylen, BT., Maher, CF., Barber, MD., et al. An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J, 2016, 27(2), p. 165–194.

11. Huang, W., Wang, T., Zong, H., Zhang, Y. Efficacy and safety of tension-free vaginal tape-secur mini-sling versus standard midurethral slings for female stress urinary incontinence: A systematic review and meta-analysis. Int Neurourol J, 2015, 19(4), p. 246–258.

12. Hubka, P., El Haddad, R., Mašata, J., et al. Predilekční místa pro poranění při páskových operacích pro stresovou inkontinenci moči u žen. Actual gyn, 2015, 7, p. 17–20.

13. Ingelman-Sundberg, A. Extravaginal plastic repair of the pelvic floor for prolapse of the bladder neck. Gynecol Obstet Investigation, 1947, 123(4), p. 242–254.

14. Jacquetin, B. Use of „TVT“ in surgery for female urinary incontinence. J Gynecol Obstet Biol Reprod (Paris), 2000, 29(3), p. 242–247.

15. Jurakova, M., Huser, M., Belkov, I., et al. Prospective randomized comparison of the transobturator mid-urethral sling with the single-incision sling among women with stress urinary incontinence: 1-year follow-up study. Int Urogynecol J, 2016, 27(5), p. 791–796.

16. Kasi, AD., Pergialiotis, V., Perrea, DN., et al. Polyacrylamide hydrogel (Bulkamid®) for stress urinary incontinence in women: a systematic review of the literature. Int Urogynecol J [online]. 26.7.2015 [cit. 2016-02-19]. Dostupné z:

17. Kelly, HA. Incontinence of urine in women. Urol Cutaneous Rev XVII, 1913, p. 291–293.

18. Komesu, YM., Schrader, RM., Ketai, LH., et al. Epidemiology of mixed, stress, and urgency urinary incontinence in middle-aged/older women: the importance of incontinence history. Ing Urogynecol J [online]. 15.12.2015 [cit. 2016-02-19]. Dostupné z:

19. Krhut, J., Zvara, P., Gärtner, M. „Bulking agents“ v léčbě stresové inkontinence moči – současný stav a budoucí perspektivy. Čes Gynek, 2015, 80(2), s. 156–160.

20. Krofta, L., Feyereisl, J., Otčenášek, M., et al. Chirurgická léčba stresové inkontinence moči pomocí tahuprosté vaginální pásky. Čes Gynek, 2008, 73(4), s. 231–239.

21. Kuuva, N., Nilsson, CG. A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand, 2002, 81(1), p. 72–77.

22. Lapitan, MCM., Cody, JD. Open retropubic colposuspension for urinary incontinence in women. THE COCHRANE COLLABORATIONEd. Cochrane Database Syst Rev [online]. 13.6.2012 [cit. 2016-02-19]. Dostupné z:

23. Legendre, G., Fritel, X., Capmas, P., et al. Urinary incontinence and obesity. J Gynecol Obstet Biol Reprod (Paris), 2012, 41(4), p. 318–323.

24. Marshall, VF., Marchetti, AA., Krantz, KE. The correction of stress incontinence by simple vesicourethral suspension. Surg Gynecol Obstet, 1949, 88(4), p. 509–518.

25. Martan, A., Krhut, J., Mašata, J., et al. Prospective randomized study of miniarc and ajust single incision sling procedures. Low Urin Tract Symptoms, 2014, 6(3), p. 172–174.

26. Martan, A., Masata, J., Svabík, K., Krhut, J. Transurethral injection of polyacrylamide hydrogel (Bulkamid®) for the treatment of female stress or mixed urinary incontinence. Eur J Obstet Gynec Reprod Biol, 2014, 178, p. 199–202.

27. Martan, A., Mašata, J., Švabík, K., et al. [Transurethral injection of polyacrylamide hydrogel (Bulkamid®) for the treatment of recurrent stress urinary incontinence after failed tape surgery]. Ces Gynek, 2015, 80(1), s. 25–29.

28. Martan, A., Mašata, J., Švabík, K. Nové operační a léčebné postupy v urogynekologii: řešení stresové inkontinence moči, defektů pánevního dna a OAB u žen. 2. rozšířené a přepracované vydání. vyd. Praha: Maxdorf, 2013. 254 s. ISBN 978-80-7345-348-0.

29. Masata, J., Svabik, K., Zvara, K., et al. Comparison of the efficacy of tension-free vaginal tape obturator (TVT-O) and single-incision tension-free vaginal tape (Ajust™) in the treatment of female stress urinary incontinence: a 1-year follow-up randomized trial. Int Urogynecol J, 2016, 27(10), p. 1497–1505.

30. Milsom, I., Altman, D., Lapitan, MC., et al. Epidemiology of urinary (UI) and faecal (FI) incontinence, pelvic organ prolapse (POP). [online]. 4th. vyd. Plymouth: Health Publication Ltd., 2009. Dostupné z:

31. Mostafa, A., Lim, CP., Hopper, L., et al. Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence: an updated systematic review and meta-analysis of effectiveness and complications. Eur Urol, 2014, 65(2), p. 402–427.

32. Nambiar, A., Cody, JD., Jeffery, ST. Single-incision sling operations for urinary incontinence in women. THE COCHRANE COLLABORATIONEd. Cochrane Database Syst Rev [online]. 1.6.2014 [cit. 2016-02-19]. Dostupné z:

33. Nilsson, CG., Kuuva, N., Falconer, C., et al. Long-term results of the tension-free vaginal tape (TVT) procedure for surgical treatment of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct, 2001, 12 Suppl 2, p. S5–8.

34. Pai, A., Al-Singary, W. Durability, safety and efficacy of polyacrylamide hydrogel (Bulkamid(®)) in the management of stress and mixed urinary incontinence: three year follow up outcomes. Cent European J Urol, 2015, 68(4), p. 428–433.

35. Pereyra, AJ. A simplified surgical procedure for the correction of stress incontinence in women. West J Surg, 1959, 67, p. 223–226.

36. Peters, KM., Dmochowski, RR., Carr, LK., et al. Autologous muscle derived cells for treatment of stress urinary incontinence in women. J Urol, 2014, 192(2), p. 469–476.

37. Petros, PE., Ulmsten, UI. An integral theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand, Suppl, 1990, 153, p. 7–31.

38. Serati, M., Sorice, P., Bogani, G., et al. TVT for the treatment of urodynamic stress incontinence: Efficacy and adverse effects at 13-year follow-up. Neurourol. Urodyn. [online]. 19.10.2015Dostupné z:

39. Stamey, TA. Endoscopic suspension of the vesical neck for urinary incontinence. Surg Gynecol Obstet, 1973, 136(4), p. 547–554.

40. Stanton, SL., Reynolds, SF., Creighton, SM. The modified Pereyra (Raz) procedure for genuine stress incontinence – A useful option in the elderly or frail patient? Inter Urogynecol J Pelvic Floor Dysfunct, 1995, 6(1), p. 22–25.

41. Svenningsen, R., Staff, AC., Schiøtz, HA., et al. Long-term follow-up of the retropubic tension-free vaginal tape procedure. Int Urogynecol J, 2013, 24(8), p. 1271–1278.

42. Tanagho, EA. Colpocystourethropexy: the way we do it. J. Urol, 1976, 116(6), p. 751–753.

43. Thubert, T., Deffieux, X., Letouzey, V., Hermieu, JF. Obésité et urogynécologie : revue de la littérature. Progrès en Urologie, 2012, 22(8), p. 445–453.

44. Tommaselli, GA., Di Carlo, C., Formisano, C., et al. Medium-term and long-term outcomes following placement of midurethral slings for stress urinary incontinence: a systematic review and metaanalysis. Inter Urogynecol J, 2015, 26(9), p. 1253–1268.

45. Ulmsten, U., Henriksson, L., Johnson, P., Varhos, G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct, 1996, 7(2), p. 81–86.

46. Ulubay, M., Ozturk, M., Keskin, U., et al. Long term patient satisfaction of burch colposuspension with or without concomitant total abdominal hysterectomy. J Clin Diagn Res, 2015, 9(12), p. QC01-03.

47. Vancaillie, TG., Schuessler, W. Laparoscopic bladderneck suspension. J Laparoendosc Surg, 1991, 1(3), p. 169–173.

48. Ward, KL., Hilton, P., UK and Ireland TVT Trial Group. A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up. Am J Obstet Gynecol, 2004, 190(2), p. 324–331.

49. Zhang, P., Fan, B., Zhang, P., et al. Meta-analysis of female stress urinary incontinence treatments with adjustable single-incision mini-slings and transobturator tension-free vaginal tape surgeries. BMC Urol, 2015, 15, p. 64.

50. Zhou, Q., Song, Y., Chen, J., et al. [Meta-analysis of clinical efficacy of TVT-S versus TVT-O/TOT in the treatment of stress urinary incontinence]. Zhonghua Yi Xue Za Zhi, 2012, 92(37), p. 2632–2635.

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

Article was published in

Czech Gynaecology

Issue 1

2017 Issue 1

Most read in this issue
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account