Minimally invasive procedures for urethral incontinence: is there a role for laparoscopy?

This article focuses on the minimally invasive surgical approaches for the treatment of stress urinary incontinence (SUI). The role of laparoscopic suspension is reviewed and compared with other minimally invasive techniques, such as the pubovaginal sling procedure and injection of the urethral bulking agents. The role of laparoscopic Burch colposuspension remains ill defined in 2002. Once this minimally invasive technique is shown to duplicate the success rate of the open Burch procedure, it could be offered as a first-line therapy to patients with SUI. At this time, the pubovaginal sling (PVS) offers the best long-term results with acceptable low complication rates of urinary retention, urgency, and sling erosion or infection. These complications are rarely seen with the laparoscopic repair but the incidence of bladder injuries is higher. The PVS operation can be performed as a salvage procedure, in obese patients, and concomitant with cystocele and rectocele repair whereas data for laparoscopy in these conditions are lacking. Until the long-term efficacy of the laparoscopic repair is clearly defined, offering it to patients as a minimally invasive therapy denies them of procedures with superior efficacy.