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In the last few years the sling became the preferred technique for the treatment of stress urinary incontinence (SUI) as much for intrinsic sphincterian deficiency (Type III), as for urethral hypermobility1. As these two forms can coexist in the same patient, the using of the sling corrects in an adequate manner the urinary loss of the patient.
The refinement of the surgical techniques evolved to more effective results and a lower index of complications. The results in a long range of time are excellent, when compared to other forms of SUI treatments2,3.
The concept of using the urethral supports (slings) for the treatment urinary incontinence is old, having been introduced almost 100 years ago by Giordano and later by Goebells. The loss of initial enthusiasm is due to technical difficulties and to a high degree of complications. With the passing of time, from 1999, with the low effective results of endoscopic suspensions and with the simplification techniques of the slings, these were more accepted in the urological practice4,5.
The objective of placing the sling is to position a tape of natural material or synthetic, under the urethra, to reestablish a sufficient resistance to the vesical emptying. This way, the urethra that presents an intrinsic lesion can avoid urinary loss at the moment of stress maneuvers. In the same sense we must avoid an obstructive process, allowing a spontaneous urination. Besides this, the sling may also correct the urethra's anatomic position.
Nowadays, the theory that predominates in SUI shows that it is more important to sustain the urethra than its compression. With the appropriate technique of placing the sling there should be no compression of the urethra, but just its sustentation at the moment of intra-abdominal enlargement of pressure, so there is no urinary loss at that moment.
Many techniques were described of how to place the sling. The surgical approach may be abdominal, transvaginal or combined. The materials used may be autologous, such as abdominal rectal fascia, lata fascia, vaginal wall. The sling may also be cadaver lata fascia, nowadays used frequently. In relation to synthetics, like gorotex, silastic, merselene or dacron, are rarely used. The exception is the polypropilene sling. (TVT), whose indication is increasing each day, because of its technical simplicity, quick execution, and adequate results in the average.