Objective: To review the surgical routes currently used in the treatment of female stress urinary incontinence (SUI).
Patients and methods: We have carried out a review of the international literature on Medline between 1968 and 2004, on surgical techniques for the treatment of female stress urinary incontinence (SUI). We have analysed articles that permitted to understand the evolution of surgical routes for 35 years. We have also sent a postal questionnaire to all Gynecology and Urology departments from the 25 University Hospitals of the Assistance Publique - Hopitaux de Paris (AP-HP) in France. All these departments were interviewed on the number of procedures performed between 1(st) September 2002 and 31(st) August 2003, the techniques used, the types and surgical routes of sub-urethral slings.
Results: We report principles, results and morbidity of the surgical routes currently used in the treatment of female SUI: Burch colposuspension, Goebell-Stoeckell operation, sub-urethral prosthetic slings (retro-pubic and trans-obturator), urethral injections and artificial urinary sphincter. As regards the postal questionnaires, we have obtained answers from 22 departments out of 25 (88%). The total number of procedures for surgical treatment of SUI was 1224, 586 by the gynecologist (47.9%) and 638 by the urologist (52.1%). The techniques used were: 1028 sub-urethral prosthetic slings (83.9%), 106 Burch colposuspensions (8.7%), 70 artificial urinary sphincters (5.7%), 13 Goebell-Stoeckell operations (1.1%) and 7 urethral injections (0.6%). The tapes used were: 614 TVT (59.7%), 217 TOT (21.1%) - Uratape or Obtape -, 111 SPARC (10.8%), 40 PROLENE (3.9%), 27 URETEX (2.6%), 7 PELVICOL (0.7%), 6 SIS (0.6%) and 6 IVS (0.6%). The surgical routes were: retro-pubic down-up in 60.2%, trans-obturator in 26.9%, retro-pubic up-down in 10,8% and pre-pubic in 2.1%.
Discussion and conclusion: The TVT procedure is widely used for surgical treatment of female SUI. The trans-obturator approach, which allows a morbidity reduction, was the route of choice in more than 25% at the AP-HP in 2002-2003.