Tension-Free Mini-Invasive Anti-Incontinence Procedures: Comparison Among Three Main Pathways

Objective. To evaluate both results and complications of Retro-pubic, Pre-pubic and Trans-obturator miniinvasive anti-incontinence surgical procedures. Material and methods. Search of PubMed, Cochrane library and relevant articles from 1996 to 2012. Results. Seventy-four works were found. Literature showed similar cure rates among retro-pubic (71,4-91%), transobturator (77,3-95%) and pre-pubic (81-87,2%) anti-incontinence procedures. Cystoscopy is considered as necessary in the retro-pubic, optional in the trans-obturator, unnecessary in the pre-pubic procedure. Intra-operative cough stress test is believed to be useful only when using the retro-pubic and the pre-pubic path. Obstruction symptoms prevail in the retropubic, are rare in the trans-obturator and not recorded in the pre-pubic procedure. The erosion rate is similar for the all the three techniques. Permanent catheterization is found in 3% of the retro-pubic technique group. The retro-pubic path may be mainly performed for the cure of recurrent stress incontinence (RSI) and intrinsic sphincter deficiency (ISD) in absence of obstructive symptoms. Due to the danger involved in the retro-pubic space, intra-operative vascular and perforating risks prevail in the retro-pubic procedure, whereas the onset of late infective complications in the trans-obturator technique is due to the site of the mesh tip that may interfere with the movements of the thigh. No severe complications were reported in the pre-pubic procedure. Conclusion. In the severe cases of SUI, RSI and in ISD the retro-pubic tension-free route remains the favourite; when obstructive symptoms prevail, the prepubic technique is the most appropriate; whereas for all other cases, the trans-obturator procedure is the most suitable.