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The using of the autologous pubovaginal sling has been the choice conduct in the treatment of complex Stress Urinary Incontinence (SUI) 1. This preference in relation to synthetic materials is due to two basic worries that we know: implant infection and urethral erosion2.
On the other hand the using of synthetic slings enables the transformation of a big surgery into a minimally invasive approach, reducing not only surgical time, but also, hospitalization, post-operative discomfort and recuvery time.
The TVT was recently introduced in the therapeutic armamentarium (Tension-free vaginal Tape), a synthetic pubovaginal sling applied without tension, which eliminated the urethral erosion.
The change of the paradigm does not only reside in the elimination of tension which was already extolled by many authors, but mainly by the setting of the sling vaginal way, in the mid and distal urethra, and not at the level of the bladder neck3.
In accordance with the integral theory of continence4 the pubourethral ligament combined with the musculature of the pelvic floor make the mid and distal urethra the most important regions of urinary incontinence.
These new conceptions, associated to the fact that sling surgeries are used more and more, mainly by urologists, this makes the TVT an attractive alternative for the surgical treatment of SUI.