Treatment of stress urinary incontinence using a single incision sling, quality of fixation of implants into the obturator complex and its influence by infiltration anesthesia

Vollständiger Abstract

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This article reviews current surgical options for treatment of stress urinary incontinence (SUI), focusing on Single Incision Sling (SIS) systems and the effect of infiltration anesthesia on implant fixation within the obturator complex. By analyzing the current literature, this study highlights the advantages of minimally invasive approaches – such as reduced surgical burden, shorter recovery time, and lower economic costs – while identifying their limitations in long-term efficacy. Anatomical and technical factors responsible for failure of different generations of SIS are discussed, particularly inadequate fixation and incompatibility with variable pelvic dimensions. Special attention is paid to infiltration anesthesia, which can alter tissue perfusion and cause local tissue loosening, thereby reducing anchor stability. Despite the procedural advantages of SIS, the retropubic approach remains the gold standard due to its higher long-term success rate and stability. The article emphasizes the importance of individualized surgical planning and calls for further studies aimed at optimizing both minimally invasive techniques and anesthetic protocols. It also emphasizes initial conservative therapy and the use of bulking agents to treat SUI. Key words: stress urinary incontinence – surgical treatment – tension free vaginal tape – obturator complex – infiltration anesthesia – Single Incision Sling – bulking agent