Joint Position Statement on Midurethral Slings for Stress Urinary Incontinence.

T he purpose of this Position Statement by the American Urogynecologic Society (AUGS) and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) is to support the use of the midurethral sling (MUS) for the surgical management of stress urinary incontinence (SUI). Developed in the 1990s, the MUS treats SUI in a minimally invasive, outpatient procedure. This technique uses a small mesh strip composed ofmonofilament polypropylene placed through the vagina under the midurethra and exiting from 2 small sites in either the suprapubic or groin area. They are often referred to as full-length slings to differentiate them from smaller single-incision slings or mini slings. This document refers to the full-length MUS. Stress urinary incontinence, defined as the involuntary urine leakage associated with coughing, sneezing, or other types of exertion, is prevalent, with 13.6% of women in the United States having had at least 1 surgical procedure for SUI in their lifetime, resulting in 260,000 continence surgical procedures annually. Stress urinary incontinence is often a bothersome and even debilitating condition that can substantially reduce a woman’s quality of life. Although nonsurgical treatments such as pelvic floor exercises and vaginal inserts (or pessaries) are helpful in alleviating symptoms in some women, many proceed with surgery, which is a more effective, durable treatment. In 2011, the U.S. Food and Drug Administration (FDA) issued a public health notification regarding adverse events associated with transvaginal mesh used to treat pelvic organ prolapse. In 2019, the FDA ordered the manufacturers of surgical mesh products indicated for the transvaginal repair of pelvic organ prolapse to stop selling and distributing their products in the United States. The media attention and litigation surrounding these FDA announcements have resulted in confusion between transvaginal mesh used to treat pelvic organ prolapse and the MUS used to treat SUI. This may have led to a negative perception of the MUS. In 2019, the FDA reaffirmed the findings of its safety panel and literature review stating that the safety and effectiveness of the full-length MUS is well established. The FDA has not recalled or published warnings against the full-length MUS.Most experts who dealwith female SUI are supportive of the use of theMUS and the majority of women who have had one placed are satisfied.