In this article, we discuss the evolution of mid-urethral sling kits, outline the advantages and disadvantages of three distinct approaches to MUS placement, and provide an overview of our algorithm for procedure selection.
A variety of MUS kits have evolved since the advent of the original TVT™ sling, including the suprapubic arc (SPARC) sling system (American Medical Systems, Minnetonka, MN), which is a retropubic MUS placed using a "top-down" approach. Transobturator tapes (TOT) are the most popular type of MUS and may be placed from an "inside-out" technique, using the TVT-O™ (Ethicon), or an "outside-in" approach, using the Monarc (AMS).
In 2006, even less-invasive, single-incision kits such as the Gynecare TVT SECUR (Ethicon) and later, the MiniArc (AMS), were introduced. This latest innovation allows the MUS to be placed through a single vaginal incision.