[Surgical treatment of female stress urinary incontinence: where are we in 2011?].

Female stress urinary incontinence (SUI) is mainly due to an excessive mobility of the cervico-urethral complex. Synthetic tapes placed without tension underneath the urethra to correct this hypermobility have revolutionized the surgical treatment of female SUI for the past fifteen years. The retropubic approach, namely the "tension-free vaginal tape" (TVT), was designed in 1996. It generates high SUI cure rates but is associated with a risk of intrapelvic bleeding and bladder and intestine perforation. The inside-out transobturator approach, which was developed eight years ago in our Institution, has since been used worldwide. The surgical technique is simple and reproducible and the incidence of peri- and post-operative complications is reduced. SUI cure rates are +/- 90% after a 3-5 years follow-up, similar to those obtained after the retropubic route. We have recently improved our original technique by using a shorter tape while, at the same time, minimizing the dissection required for its insertion. After a one year minimum follow-up, this new technique appears as safe and efficient as the traditional transobturator technique but is associated with reduced post-operative groin pain. We introduce for the first time the concept of the transobturator "midi sling".