Sling failures: what's next?

The pubovaginal sling has been used to treat anatomic, functional, and recurrent stress urinary incontinence for decades with excellent results. Nevertheless, enthusiasm for the pubovaginal sling is tempered by the surgical morbidity and postoperative voiding dysfunction associated with it. New modifications such as alternative sling materials, bone anchor suspension, and midurethral slings have been developed to reduce operating time and surgical morbidity. The less invasive approaches are now well recognized and midurethral slings have become the most common procedure performed for stress urinary incontinence. Despite the ubiquity of sling procedures in all of their forms, there is no consensus on the management of sling failures. Recent literature suggests that similar to primary genuine stress incontinence, recurrent stress urinary incontinence as a result of sling failure is being successfully managed with less invasive techniques.