Update on Single-incision Slings.

Abstract

Importance: Single-incision slings (SIS) offer a minimally invasive option for treating stress urinary incontinence (SUI), aiming to reduce operative time, postoperative pain, and recovery compared to traditional slings. Their growing use underscores the importance of understanding their effectiveness, safety profile, and long-term outcomes to ensure optimal patient care.

Objective: The objective was to update current evidence on the safety, efficacy, and economic impact of SISs for the treatment of SUI in women.

Study design: A structured literature review was conducted using PubMed, Cochrane Library, and the U.S. Food and Drug Administration (FDA) 522 Postmarket Surveillance Studies Database up to December 2024. Inclusion criteria were randomized controlled trials, prospective observational studies, meta-analyses and the FDA summary addressing SIS outcomes. Key metrics included objective and subjective cure rates, complications, and economic evaluations.

Results: A total of 28 publications were reviewed since the most recent Cochrane review in 2023. Overall, high subjective (73.3% to 94.2%) and objective cure rates (61.5% to 94%) continue to be reported for SISs with operative times of 10.7 to 20.4 min and low adverse events of mesh complications (0% to 14.2%), reintervention procedures (0% to 16.3%) and de novo urgency urinary incontinence (0% to 15%) up to 36 months. Economic analyses revealed short-term cost savings for SISs, particularly in outpatient settings under local anesthesia, though cost-effectiveness over longer periods remains uncertain due to potential retreatment and/or complications.

Conclusions: Single-incision slings offer a minimally invasive option for SUI with comparable efficacy to full-length midurethral slings, with rare perioperative complications and short operative times. Long-term outcomes on complications and durability are needed. Future studies are needed to guide clinical decision making, particularly regarding longer-term complications and cost-effectiveness.