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PubMed2003

Vaginal ring delivery of hormone replacement therapy--a review.

Vaginal ring delivery systems are a highly promising approach to hormone replacement therapy (HRT). The vagina is an excellent route for steroid absorption. Menopausal vaginal rings can be designed to allow very low dose local delivery of oestrogen to the vagina for the large percentage of postmenopausal women experiencing urogenital atrophy, or can be modified to deliver much higher doses sufficient for systemic oestrogen replacement therapy, with or without simultaneous progestogen release. Clinical studies of ultra-low dose rings have shown them to be as efficacious as established treatments of urogenital atrophy (creams, pessaries) and to be preferred by most users. Pharmacokinetic and limited clinical studies of vaginal rings designed to deliver systemic doses of HRT (oestrogen alone or combined) have also been highly promising. Vaginal ring delivery of HRT offers women convenient, long-acting therapy (>/= 3 months) that is under their own personal control.

Administration, Intravaginal↗

PubMed2005

"Shotgun" versus sequential testing. Cost-effectiveness of diagnostic strategies for vaginitis.

BACKGROUND: Although vaginitis is a common outpatient problem, only 60% of patients can be diagnosed at the initial office visit of a primary care provider using the office procedures of pH testing, whiff tests, normal saline, and potassium hydroxide preps. OBJECTIVE: To determine the most cost-effective diagnostic and treatment approach for the medical management of vaginitis. DESIGN: Decision and cost-effectiveness analyses. PARTICIPANTS: Healthy women with symptoms of vaginitis undiagnosed after an initial pelvic exam, wet mount preparations, pH, and the four criteria to diagnose bacterial vaginosis. SETTING: General office practice. METHODS: We evaluated 28 diagnostic strategies comprised of combinations of pH testing, vaginal cultures for yeast and Trichomonas vaginalis, Gram's stain for bacterial vaginosis, and DNA probes for Neisseria gonorrhoeae and Chlamydia. Data sources for the study were confined to English language literature. MEASUREMENT: The outcome measures were symptom-days and costs. RESULTS: The least expensive strategy was to perform yeast culture, gonorrhoeae and Chlamydia probes at the initial visit, and Gram's stain and Trichomonas culture only when the vaginal pH exceeded 4.9 (330 dollars, 7.30 symptom days). Other strategies cost 8 dollars to 76 dollars more and increased duration of symptoms by up to 1.3 days. In probabilistic sensitivity analysis, this strategy was always the most effective strategy and was also least expensive 58% of the time. CONCLUSIONS: For patients with vaginitis symptoms undiagnosed by pelvic examination, wet mount preparations and related office tests, a comprehensive, pH-guided testing strategy at the initial office visit is less expensive and more effective than ordering tests sequentially.

Adult↗

PubMed1989

Hormonal control of the cervix in pregnant gilts. II. Relaxin promotes changes in the physical properties of the cervix in ovariectomized hormone-treated pregnant gilts.

The effects of relaxin on the physical properties of both the uterine and vaginal portions of the cervix were studied between days 80 and 110 of pregnancy in ovariectomized gilts given progesterone to maintain pregnancy. In controls gilts the extensibility, lumen diameter, and wet weight of the uterine portion of the cervix were less than those of the vaginal portion of the cervix on day 80, but increased thereafter, and by day 110 did not differ (extensibility and wet weight) or approached (lumen diameter) those values of the vaginal portion of the cervix. When gilts were ovariectomized on either days 80 or 100 and given progesterone only (groups OP-100 and OP-110) extensibility, lumen diameter, and wet weight failed to increase in both the uterine and vaginal portions of the cervix. After replacement therapy with progesterone plus relaxin (groups OPR-100 and OPR-110), extensibility, lumen diameter, and wet weight increased to values as least as large as those in control groups in both portions of the cervix. In all groups the uterine portion of the cervix changed more dramatically than the vaginal portion. After hormone replacement therapy, blood levels of relaxin were moderately higher, and blood levels of progesterone were somewhat lower than those in control gilts. There was little or no difference in estrogen levels between ovariectomized and control gilts. We conclude that relaxin plays an important role in promoting increased growth and extensibility in both the uterine and vaginal portions of the cervix after day 80 of gestation in the gilt.

Animals↗

PubMed2001

Single and multiple exposure tolerance study of cellulose sulfate gel: a Phase I safety and colposcopy study.

Vaginally applied gels offer a promising approach for preventing unwanted pregnancies and sexually transmitted infections. Cellulose sulfate (CS) is a non-cytotoxic antifertility agent that also exhibits in vitro antimicrobial activity against sexually transmitted pathogens, including HIV. This was a randomized, double-blinded, Phase I study of 2.5 mL and 5.0 mL doses of 6% CS gel. A single vaginal application of the gel followed by five consecutive daily doses was assessed for genital irritation, safety, vaginal leakage, and product acceptability compared to two controls, Conceptrol, which is a marketed contraceptive gel containing nonoxynol-9, and K-Y jelly. The results suggest that the safety of 6% CS was comparable to that of Conceptrol and K-Y jelly, and it may be associated with less genital irritation. The 2.5 mL dose of CS may be preferable according to the participants' reports of leakage. All the products had similar acceptability profiles.

Administration, Intravaginal↗

PubMed1995

Group B streptococcal disease in newborns: a global perspective on prevention.

Group B Streptococcus (GBS) is an important cause of neonatal sepsis in many areas. Although incidence data are available for a minority of countries, the magnitude of illness due to this bacterium appears to vary substantially. Disease may vary due to the prevalence of asymptomatic GBS colonization, the virulence of circulating strains, the frequency of predisposing conditions such as low birth weight, or differences in obstetric practices. Approaches to prevention of neonatal GBS disease include administering antibiotics to high risk mothers intrapartum, use of intrapartum vaginal disinfectants, development of GBS vaccines, and nonspecific approaches. Determinants of prevention policies in a given area depend on the incidence of disease, the structure of health care delivery, cost-effectiveness, and cultural attitudes. Much GBS disease among newborns is now preventable, yet data on incidence are needed to guide selection of appropriate approaches to disease prevention.

Female↗

PubMed2001

Effectiveness of syndromic approach in management of reproductive tract infections in women.

Syndromic approach was used to identify reproductive tract infections (RTI) by a trained public health nurse among 130 ever-married women aged 15-45 years selected by a systematic random sampling method in a resettlement colony, Chandigarh. A lady medical officer in the dispensary examined and treated 48 (37%) referred symptomatic women as per syndromic approach guidelines. They were suffering from vaginitis (52.1%), cervicitis (20.8%), pelvic inflammatory disease (PID) (14.6%), urinary tract infections and PID (4.2%) and 4 did not have any clinical abnormality. Poor menstrual hygiene was observed among 72.7% women with RTI. Follow-up done after one month showed effectiveness in terms of symptomatic relied in 72.7% while 9.1% discontinued treatment and 4.5% did not comply with the medications. Training of nurses, health workers, dais, anganwadi workers regarding RTI identification and referral using syndromic approach and promotion of menstrual hygiene, genital hygiene and health care seeking behaviour would help in reducing the burden of RTI in the community.

Adolescent↗

PubMed2000

Treatment with 2% clindamycin vaginal cream prior to first trimester surgical abortion to reduce signs of postoperative infection: a prospective, double-blinded, placebo-controlled, multicenter study.

BACKGROUND: Bacterial vaginosis (BV) and intermediate flora is known risk-factor for postoperative infection after surgical termination of pregnancy. Vaginal application of 2% clindamycin cream is an efficacious treatment for BV, but it is not known whether preoperative administration of clindamycin cream might reduce the signs of post-abortion infection after surgical termination of pregnancy. AIM: To evaluate whether preoperative treatment with clindamycin cream might reduce the signs of post-abortion infection after legal abortion. DESIGN: Prospective, double-blinded, placebo-controlled, multicenter study. MATERIAL AND METHODS: Consecutive women attending for surgical termination prior to 11+4 gestational weeks were approached. We randomized participants to preoperative vaginal treatment with 2% clindamycin cream or placebo cream in a double-blinded fashion. At all visits vaginal smears were air dried on microscopy slides to be stored. The rate of postoperative pelvic infection according to our definition was the main outcome variable, the cure rates of BV and of intermediate flora were secondary outcome variables. RESULTS: Of 1655 enrolled women, 1102 were evaluable for analyses. Fifty-eight women developed signs of post-abortion infection. Preoperative treatment with clindamycin cream significantly (RR: 4.2, 95% C.I. 1.2-15.9) reduced the risk of post-abortion infection among women with abnormal vaginal flora (BV and intermediate flora). Treatment with clindamycin cream in women with normal lactobacilli flora did not demonstrate any difference compared to the non-treatment group. CONCLUSION: Preoperative treatment for at least three days with clindamycin cream significantly reduced the risk for developing signs of post-abortion infection only among women with preoperative abnormal vaginal flora (BV and intermediate flora).

Abortion, Induced↗

PubMed2004

The scope of vaginal hysterectomy.

OBJECTIVE: The study was designed to check the feasibility of the vaginal route as the primary route for hysterectomy. STUDY DESIGN: All patients in whom hysterectomy was indicated were first considered for vaginal hysterectomy unless this route was contraindicated. Vaginal hysterectomy (VH) was performed in 5655 patients, and in 90.4% of these no uterine prolapse was present. The operative intervention required, preconditions and any complications were carefully studied. RESULTS: Of the 6945 cases considered, vaginal hysterectomy was possible in 5655 (81%). Successful simultaneous prophylactic oophorectomy or salpingo-oophorectomy was possible, in 1510 of 1572 cases without laparoscopic assistance. The indications are carefully discussed, with a strong emphasis on examination under anaesthesia, preoperative total uterine volume and, if required, laparoscopic evaluation and surgeons' readiness to reduce the frequency of recourse to laparotomy or laparoscopic assistance. CONCLUSION: The vaginal route is the least invasive and most economical route for hysterectomy and should be the gynaecological surgeon's first choice. A uterus with a volume up to 300 cm3 or uterine size up to 12 weeks should be dealt with vaginally, and as surgeons become more experienced larger uteri and also the adnexa can be approached in the same manner, at least as trial vaginal hysterectomy.

Adult↗

PubMed1983

Synthesis of (E)-1-(5-chlorothien-2-yl)-2-(1H-imidazol-1-yl)ethanone 2,6-dichlorophenylhydrazone hydrochloride, a novel, orally active antifungal agent.

The preparation, determination of isomeric configuration, and antifungal properties of (E)-1-(5-chlorothien-2-yl)-2-(1H-imidazol-1-yl)ethanone 2,6-dichlorophenylhydrazone hydrochloride (1) are described. In vitro, compound 1 has been shown to have activity against Candida albicans comparable with miconazole. When administered orally to animals with experimentally induced vaginal candidiasis or systemic candidiasis, compound 1 produced results approaching those produced by ketoconazole. In addition, topical administration of compound 1 to rats with vaginal candidiasis produced results comparable with those produced by similar administration of clotrimazole. Unlike ketoconazole, which is active by a mechanism that is essentially fungistatic, compound 1 shares with miconazole a mode of action that is fungicidal. However, unlike miconazole, compound 1 exhibits activity following oral administration. Compound 1 has been found to be negative in the Ames test.

Animals↗

PubMed2005

Molecular methodology in determining vaginal flora in health and disease: its time has come.

The microbial flora of the human vagina can affect the health of women, their fetuses, and newborns. Conventional cultivation methods fail to detect some fastidious vaginal bacteria, leading to an incomplete census. Recent advances in molecular biology have facilitated the detection and identification of bacteria without cultivation, and the advantages and limitations of this approach are described. Molecular studies of the vaginal flora have discovered many uncultivated bacterial species. For instance, several novel bacteria in the Clostridiales order are highly specific indicators of bacterial vaginosis, and bacteria related to Megasphaera, Leptotrichia, Atopobium, and Dialister species are commonly found in subjects with bacterial vaginosis. A more complete understanding of vaginal microbial populations resulting from the adoption of molecular tools may lead to better strategies to maintain healthy vaginal floras and will create opportunities to explore the role of novel bacteria in reproductive tract diseases.

Journal Article↗

PubMed2002

Vaginal reconstruction utilizing sigmoid colon: Complications and long-term results.

BACKGROUND/PURPOSE: The use of sigmoid colon segments to repair congenital deformities of the vagina is well established. There are little data, however, on complications or functional results in these patients. The purpose of this study was to evaluate complication rates and long-term patient outcomes in the use of sigmoid segments in vaginal reconstruction for congenital anomalies. METHODS: The authors identified 28 patients who underwent vaginal reconstruction with sigmoid colon segments between 1985 and 2000 at their institution. Patient charts were reviewed for surgical technique, complication rates, cosmetic results, functional results, and psychosocial development. Patients were recalled for physical examinations and personal interviews to assess current status. RESULTS: Of the 28 patients, 13 had male pseudohermaphroditism, 6 had Mayer-Rokitansky-Kuster-Hauser syndrome, 2 had true hermaphroditism, 2 had mixed gonadal dysgenesis, 2 had common urogenital sinus syndrome, 2 had adrenogenital syndrome, and 1 had penile agenesis. Mean patient age was 16 years (range, 6 to 21 years). Mean follow-up was 6.2 years (range, 2 months to 15 years). Postoperative complications included introital stenosis (4 patients), mucosal prolapse (4), partial small bowel obstruction (2), perineal wound hematoma (2), superficial wound infection (2), and vaginal prolapse (1). None of the complications have affected long-term patency or cosmesis of the neovagina, nor has mucous production significantly affected quality of life. Fourteen of 16 (88%) adult patients are heterosexually active, 1 is homosexually active, and 1 is asexual. Of the 14 heterosexually active patients, 11 (79%) are "very satisfied" with their psychosexual development and 3 are "comfortable." Four patients are married, and 1 has carried a child to term. All adult patients felt that the appropriate time to undergo surgery was in adolescence. CONCLUSIONS: Reconstruction with sigmoid segments is an effective approach for many congenital conditions requiring vaginal reconstruction. Although surgical outcomes are not perfect, appropriately timed reconstructive vaginal surgery can provide most patients with an improved quality of life. For the best long-term results, a multidisciplinary team must be available from infancy to supply comprehensive support.

Adolescent↗

PubMed1980

[Surgical treatment of female urinary incontinence relapses (author's transl)].

Within the period of 4 years 35 patients with urinary incontinence relapses have been treated surgically using modified Marshall-Marchetti-Krantz method and Lyodura-snare operation. In the group of patients who have been treated with the Lyodura-snare, 13 uterus had to be extirpated vaginally and two times by abdominal approach. 22 patients have been additionally treated by anterior colporrhaphy. In 10 patients with urinary incontinence relapse and simultaneous intraabdominal pathological changes, a laparotomy and abdominal suspension of paraurethral tissue were performed according to the modified Marshall-Marchetti-Krantz method. After an observation period of 4-1 years all patients were continent.

Adult↗

PubMed2004

A nonincisional, Doppler-guided transvaginal approach to uterine artery identification and control of uterine perfusion.

STUDY OBJECTIVE: To determine the location and depth of uterine arteries from the vaginal fornix using a Doppler-guided nonincisional transvaginal approach. DESIGN: Observational study (Canadian Task Force classification II-3). SETTING: Two women's health and fertility centers. PATIENTS: One hundred nine healthy premenopausal women (age >18 yrs). INTERVENTION: Transvaginal uterine artery identification. MEASUREMENTS AND MAIN RESULTS: After uterine size and position were determined, with a standard bivalve speculum in place, uterine arteries were located bilaterally using the DWL Multi-Dop B+ system with 8-MHz probe (Sipplingen, Germany) in toggle mode. Continuous Doppler mode was used to locate uterine arteries, and pulsed Doppler to estimate depth of the arteries from the vaginal fornix. The average uterine size was less than 8 weeks, with the largest measuring 18 weeks' gestational size. The right uterine artery could be identified between 8 and 11 o'clock positions, and was most commonly found at the 9 o'clock position (average depth 9.30 mm, range 4-17 mm). The left uterine artery could be identified between 1 and 4 o'clock positions and was most commonly found at the 3 o'clock position (average depth 8.88 mm, range 4-15 mm). CONCLUSION: Due to ease of identification of uterine arteries transvaginally, despite differences in parity, uterine size, and position, access to and occlusion of uterine arteries with a Doppler-guided device might offer an alternative to invasive procedures intended to occlude uterine artery blood flow in women with symptomatic uterine leiomyomas.

Adult↗

PubMed1994

Laparoscopic hysterectomy.

Laparoscopic hysterectomy is a substitute for abdominal hysterectomy and not for vaginal hysterectomy. Most hysterectomies currently performed with an abdominal approach may be performed with laparoscopic dissection of part or all of the abdominal portion followed by vaginal removal, including fibroids of 1000 g. There are many surgical advantages, particularly magnification of anatomy and pathology, easy access to the vagina and rectum, and the ability to achieve complete haemostasis and clot evacuation during underwater examination. Patient advantages are multiple and are related to avoidance of a pain producing abdominal incision. They include a reduced period of hospitalization and recuperation and an extremely low rate of cuff infection and ileus. It must be emphasized that conversion to laparotomy when the surgeon becomes uncomfortable with the laparoscopic approach should never be considered a complication; it is rather a prudent surgical decision that will profoundly decrease patient risk. The laparoscope can be used in combination with hysterectomy in a variety of ways with significant surgical and patient advantages. With few exceptions, laparoscopic hysterectomy can replace abdominal hysterectomy. Surgical outcome is the same. In experienced hands, the complication rate is low. Patient benefits are related to avoidance of an abdominal incision and include improved cosmetics and more rapid recovery.

Endometriosis↗

PubMed2001

Three-dimensional ultrasound of the female urethra: comparing transvaginal and transrectal scanning.

OBJECTIVES: To compare transvaginal and transrectal three-dimensional ultrasound in determining the morphology and measurements of the female urethra. DESIGN: Sixty-five women who had not had surgery for incontinence or pelvic floor descent had transvaginal and transrectal sonography using a 7.5-MHz mechanical sector endoprobe with three-dimensional facilities. The multiplanar display of the scanned volumes allowed detailed morphologic assessment of the urethra and the measurement of distances and volumes. Statistical endpoints were: sagittal urethral diameter, maximum rhabdosphincter length and thickness, maximum thickness of the smooth muscle complex, and the volumes of the rhabdosphincter and the smooth muscle complex. Values were compared between the two approaches using Student's t-test and Bland-Altman analysis. RESULTS: Both vaginal and rectal scans were feasible. However, significant differences between the two approaches were found for the sagittal diameter of the urethra (8.4 +/- 1.9 mm on vaginal vs. 11.5 +/- 2.2 mm on rectal scans, P < 0.01) and the transverse diameter of the urethra's smooth muscle complex (11.2 +/- 0.3 mm on vaginal vs. 8.6 +/- 0.2 mm on rectal scans, P < 0.001). No other variables showed significant differences. Compression of the urethra and displacement under the symphysis pubis were observed when the ultrasound probe was applied vaginally. Bland-Altman analysis showed acceptable variability for differences of distances but considerable variability for the differences of volumes. CONCLUSION: The female urethra can be examined both vaginally and rectally by three-dimensional ultrasound. A transvaginally applied probe seems to have a compression effect on the urethra.

Adult↗

PubMed2005

Vaginal speculum lubrication and its effects on cervical cytology and microbiology.

The prevailing approach to Papanicolaou (Pap) and endocervical Gen-Probe(R) screening is to use an unlubricated vaginal speculum because of concerns that gel lubricant interferes with Pap smear adequacy and cervical microbiology. This study tests the hypothesis that lubrication of metal specula with a bacteriostatic gel does not increase unsatisfactory cervical cytology or decrease detection rates of endocervical Chlamydia trachomatis or Neisseria gonorrhoeae. At a publicly funded family planning clinic site, each of eight consecutive months was randomly designated by computer as an exclusively gel-lubricated or water-moistened specula use month. The assigned vaginal speculum intervention was used on all patients receiving a Pap smear and/or combination DNA probe assay for endocervical C. trachomatis and N. gonorrhoeae. From July 2003 through February 2004, 3460 Pap smears and 5535 combination probe assays for C. trachomatis and N. gonorrhoeae were collected from 6538 patients. During the 4 months of gel lubricant use, the rate of unsatisfactory cytology was 1.1% compared to 1.5% during the 4 months of water lubrication [odds ratio (OR) 0.74; 95% confidence interval (CI) 0.41-1.35]. During the 4 months of gel lubricant use, the detection rate for endocervical C. trachomatis was 1.5% compared to 1.5% (OR 1.05; 95% CI 0.67-1.62) in water lubricant months. The study population N. gonorrhoeae infection rate was too low to statistically analyze. The use of a small amount of gel lubricant on metal vaginal specula did not increase unsatisfactory cytology or decrease endocervical C. trachomatis detection rates when compared to water lubricant.

Adult↗

PubMed2002

SOGC clinical guidelines. Hysterectomy.

OBJECTIVE: To identify the indications for hysterectomy, preoperative assessment, and available alternatives required prior to hysterectomy. Patient self-reported outcomes of hysterectomy have revealed high levels of patient satisfaction. These may be maximized by careful preoperative assessment and discussion of other treatment choices. In most cases hysterectomy is performed to relieve symptoms and improve quality of life. The patient's preference regarding treatment alternatives must be considered carefully. OPTIONS: The areas of clinical practice considered in formulating this guideline are preoperative assessment including alternative treatments, choice of method for hysterectomy, and evaluation of risks and benefits. The risk-to-benefit ratio must be examined individually by the woman and her health practitioners. OUTCOMES: Optimizing the decision-making process of women and their caregivers in proceeding with a hysterectomy having considered the disease process, and available alternative treatments and options, and having reviewed the risks and anticipated benefits. EVIDENCE: Using Medline, PubMed, and the Cochrane Database, English language articles were reviewed from 1996 to 2001 as well as the review published in the 1996 SOGC guidelines. The level of evidence has been determined using the criteria described by the Canadian Task Force on the Periodic Health Examination. BENEFITS, HARMS, AND COSTS: Hysterectomy is the treatment of choice for certain gynaecologic conditions. The predicted advantages must be carefully weighed against the possible risks of the surgery and other treatment alternatives. In the properly selected patient, the result from the surgery should be an improvement in the quality of life. The cost of the surgery to the health care system and to the patient must be interpreted in the context of the cost of untreated conditions. The approach selected for the hysterectomy will impact on the cost of the surgery. RECOMMENDATIONS: Benign Disease 1. Leiomyomas: For symptomatic fibroids, hysterectomy provides a permanent solution to menorrhagia and the pressure symptoms related to an enlarged uterus. (I-A) 2. Abnormal uterine bleeding: Endometrial lesions must be excluded and medical alternatives should be considered as a first line of therapy. (III-B) 3. Endometriosis: Hysterectomy is often indicated in the presence of severe symptoms with failure of other treatments and when fertility is no longer desired. (1-B) 4. Pelvic relaxation: A surgical solution usually includes vaginal hysterectomy, but must include pelvic supporting procedures. (II-B) 5. Pelvic pain: A multidisciplinary approach is recommended, as there is little evidence that hysterectomy will cure chronic pelvic pain. When the pain is confined to dysmenorrhea or associated with significant pelvic disease, hysterectomy may offer relief. (II-C) Preinvasive Disease 1. Hysterectomy is usually indicated for endometrial hyperplasia with atypia. (I-A) 2. Cervical intraepithelial neoplasia in itself is not an indication for hysterectomy. (I-B) 3. Simple hysterectomy is an option for treatment of adenocarcinoma in situ of the cervix when invasive disease has been excluded. (I-B) Invasive Disease 1. Hysterectomy is an accepted treatment or staging procedure for endometrial carcinoma. It may play a role in the staging or treatment of cervical, epithelial ovarian, and fallopian tube carcinoma. (I-A) Acute Conditions 1. Hysterectomy is indicated for intractable postpartum hemorrhage when conservative therapy has failed to control bleeding. (II-B) 2. Tubo-ovarian abscesses that are ruptured or do not respond to antibiotics may be treated with hysterectomy and bilateral salpingo-oophorectomy in selected cases. (I-C) 3. Hysterectomy may be required for cases of acute menorrhagia refractory to medical or conservative surgical treatment. (II-C) Other Indications 1. Consultation with an oncologist or geneticist is recommended when considering hysterectomy and prophylactic oophorectomy for a familial history of ovarian cancer. (III-C) Surgical Approach 1. The vaginal route shoe should be considered as a first choice for all benign indications. The laparoscopic approach should be considered when it reduces the need for a laparotomy. (III-B) VALIDATION: Medline searches were performed in preparing this guideline with input from experts in their field across Canada. The guideline was reviewed and accepted by SOGC Council and Executive. SPONSOR: The Society of Obstetricians and Gynaecologists of Canada.

Algorithms↗

PubMed2006

Synthetic slings: which material, which approach.

PURPOSE OF REVIEW: The success in the use of the tension-free midurethral sling procedures (tension-free vaginal tape, suprapubic arch, transobturator tape) has dramatically altered the approach to the surgical management of stress urinary incontinence in women and marked a resurgence in the use of mesh. We will analyze the characteristics of synthetic meshes and explain the rationale for using monofilament materials with larger pore sizes. Thus, the purpose of this review is to introduce the surgeon to a variety of commercially available mesh materials and the characteristics that make mesh suitable for use as sling grafts. RECENT FINDINGS: Type I macroporous mesh materials appear most suitable for transvaginal implantation. Utilization of these materials in a minimally invasive retropubic or transobturator approach, promising early and intermediate follow-up data has been achieved. The outcome of these procedures in women with urethral hypermobility and genuine stress incontinence seems clear. No controlled data, however, exist to define the role of these procedures in difficult cases of stress incontinence. Newer generations of minimally invasive slings may offer treatment alternatives in these difficult cases. SUMMARY: Minimally invasive slings using Type I mesh materials are safe and effective. 'Hybrid' type slings may offer alternatives in difficult cases of stress urinary incontinence.

Gynecology↗