Mid-urethral slings are the standard surgical treatment for stress urinary incontinence due to urethral hypermobility. In recent years, single-incision slings have gained popularity as an alternative to transobturator mid-urethral slings. However, there is still no enough evidence of its efficacy and safety. This study main aim is to compare single-incision mid-urethral slings’ efficacy and complications to the standard of care transobturator mid-urethral slings.

This is a retrospective and single center analysis of female patients submitted to mid-urethral sling procedures in the Urology Department of a tertiary hospital. Female patients submitted to surgery for stress urinary incontinence due to urethral hypermobility between January 2020 and January 2024 were included. Patients also submitted to other surgical procedures at the same surgery and patients who had previous surgical interventions for stress urinary incontinence in the past were excluded. The choice of procedure (transobturator or single-incision sling) was based on surgeon experience. Complications and outcomes were recorded. Cure of stress urinary incontinence was defined clinically as patient being satisfied with no need to additional interventions.

79 patients were submitted to mid-urethral sling procedures during the study period. 4 patients were excluded because of previous surgical interventions for stress urinary incontinence in the past and 3 were excluded because of concomitant urogynecological procedures at the same surgery. 72 patients were included: 19 had single-incision slings and 53 patients had transobturator slings (the inside-out technique was performed in 20 patients, the outside-in technique was performed in 32 patients and an adjustable transobturator sling was placed in 1 patient). No complications were reported in the single-incision sling group. Nonetheless, 2 complications were reported in the transobturator sling group: 1 vaginal perforation and 1 significant thigh hematoma. All patients in the single-incision group were satisfied and considered as cured after surgery. No patients in this group reported emptying dysfunction nor de novo storage symptoms. Only 1 patient in the transobturator sling group was not considered as cured and retained significant stress urinary incontinence after surgery. No emptying symptons were reported in this group but 2 patients developed de novo storage symptom.

This study confirms that single-incision mid-urethral slings are safe and at least as effective as transobturator mid-urethral slings. Despite the unbalanced number of patients in each group, it further suggests that single-incision slings might have a lesser rate of storage symptomatology. However, larger studies are warranted to validate these results.

Single-incision mid-urethral sling procedures are safe and highly effective, and women submitted to these procedures have a very high rate of satisfaction. Therefore, single-incision mid-urethral sling procedures should be considered in all patients with stress urinary incontinence due to urethral hypermobility.