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Suburethral single incision slings in the treatment of female stress urinary incontinence: what is the evidence for using them in 2010?

OBJECTIVES
To review the present evidence supporting the use of single-incision slings for treatment of female stress urinary incontinence.


METHODS
A Pubmed search was performed using words as stress urinary incontinence, slings, single-incision slings, mini-sling, TVT-Secur(TM), MiniArc(TM), TFS, Arcusto-Arcus(TM) and Ajust(TM). This search was complemented by a review of the references from the papers found in the initial search. Only papers written in English, with a minimum of 30 cases and 6 months follow up were analyzed.


RESULTS
Sixteen papers were found with the defined characteristics, 4 of them being comparative studies. Most studies include a low number of patients with follow-up not exceeding 12 months. Techniques are easy and seem to require a short learning curve, exception being TVT-Secur(TM). Operating time is short and complications are few and mild. Generally, results at 12 months are close to those reported after conventional slings. In two comparative studies Mini-Arc(TM) was as effective as a transobturator comparator. However in two additional comparisons, single incision slings had worse outcomes than the conventional comparator.


CONCLUSION
Some single-incision slings look promising in most series and even as effective as conventional sub-urethral slings at short term evaluation. However, no experience reported by independent authors can be found. Therefore, at this moment a clear statement in favor of the widespread use of single-incision slings cannot be made. More studies must define the efficacy of these techniques against conventional sub-urethral slings. In addition, comparisons among available single-incision slings should define one ideal model.