In female stress urinary incontinence, what is a midurethral sling and what are the two common approaches?

• A. A sling placed under the mid-urethra to provide support; retropubic (TVT) and transobturator (TOT).
• B. A device inserted into the bladder to reduce capacity.
• C. A sling placed above the bladder neck.
• D. A neuromodulation device.

Answer: (A)

A midurethral sling is a strip of mesh or tape positioned under the mid-urethra to create a supportive hammock. This support helps the urethra stay closed when abdominal pressure rises (like during coughing or sneezing), reducing stress incontinence.

The two common approaches are the retropubic route, where the sling is placed behind the pubic bone to support the urethra from the back, and the transobturator route, where the sling passes through the obturator foramen to reach the urethra from the sides. Both aim to provide durable urethral support while avoiding major bladder or pelvic organ injury, but they differ in the path the sling takes and the specific risks and recovery profiles.

The other options don’t fit because this procedure is not a device placed in the bladder to reduce capacity, not a sling placed above the bladder neck, and not a neuromodulation device.