**2. Midurethral slings for SUI treatment**

292 Urinary Incontinence

2- Intrinsic sphincter deficiency (ISD): - Multiple anti-incontinence

3- Other risk factors: - Chronic in intra-abdominal

Table 1. Show various etiological factors involved in the pathophysiology of SUI.

Surgical treatment for SUI should be undertaken for women with SUI who have failed conservative treatment strategies or if the patient wants definitive treatment from the start. Over the past years, many surgical procedures have been used for the treatment of female SUI with varying degrees of success. Recently, a number of new minimally invasive surgical techniques have been developed for treatment of female SUI that aimed to decrease the morbidity, improved safety and improvement of the surgical outcomes, while maintaining the efficacy of traditional open incontinence surgery. The Tension free vaginal tape (TVT) procedure was first described and evaluated by Ulmsten et al in Sweden in 1996 **(Ulmsten et al, 1996)**, then the Transobturator tape (TOT) procedure was developed in 2001 by DeLorme to avoid the retropubic space **(DeLorme E, 2001)**. Midurethral slings (TVT and TOT) have

1. The ability to be performed under local anaesthesia in patients who are unfit for major

2. Better for young aged women due to better cosmetic appearance since there is now

Further improvement in surgical procedures towards less invasive sling technique has led to the innovation of a mini-sling e.g. TVT Secur system, which is a surgical device requiring only a single suburethral incision to be inserted **(Neuman and Shaare-Zedek, 2007)**. Mini-slings have the following advantages over the ordinary midurethral slings

1. The complications associated with suprapubic and groin incisions will be eliminated.

3. Operative time will be shorter than with other midurethral sling techniques.

3. Lower costs, shorter hospital stay, early recovery time and less postoperative pain.

open wound such the old traditional surgical methods.








procedures


pressure. - Constipation. - Smoking.

1- Bladder neck/urethral hypermobility (due to loss of urethral support):

the following advantages:

surgery.

(TVT and TOT):

2. Cystoscopy will not be necessary.
