ABSTRACT

Aim:

To critically analyse the anatomical basis of historical abdominal sling operations for the cure of urinary stress incontinence (USI).

Methods:

Historical abdominal sling operations for cure of USI were critically analyzed as regards their modus operandi from an anatomical perspective using a 15 point system: 1. Minimally Invasiveness. 2. Ease of Performance. 3. Built-in Safety of the procedure. 4. Short term complications. 5. Long term complications. 6. Applicability to obese patients and those with poor tissues. 7. Applicability to patients with previous operations for stress incontinence. 8. Blood loss. 9. Length of operation. 10. Early discharge from hospital. 11. Urinary Retention. 12. Long-term Continence. 13. Early resumption of normal activities. 14. Anatomical damage. 15. Physiological mode of action of the operation.

Results:

A critical analysis is given for abdominal slings using both natural tissues such as rectus abdominis sheath, or plastic inserts. Benefits and complications such as post-operative pain and urinary retention are detailed.

Conclusions:

The main obstacle to abdominal slings becoming day-care operations revolve around the obstruction of urination by the positioning of the sling at bladder neck. This prevents the funneling required to reduce intraurethral resistance to urine flow, potentially causing obstructed micturition. Excess pressure on the overlying stretch receptors may cause de novo urgency. Finally, the large incisions required to access the operation site may cause organ damage, hemorrhage and thrombosis.