Midurethral sling procedures are primarily used to treat which condition?

• A. Urge incontinence due to detrusor overactivity
• B. Stress urinary incontinence due to urethral instability
• C. Overflow incontinence due to bladder outlet obstruction
• D. Mixed incontinence with no predominant type

Answer: (B)

Midurethral sling procedures are designed to address stress urinary incontinence caused by urethral instability, such as urethral hypermobility or intrinsic sphincter deficiency. The sling supports the mid-portion of the urethra, creating a backboard-like support that increases urethral closure when abdominal pressure rises during activities like coughing or sneezing. This prevents leakage in situations where leakage results from a sudden push on the bladder, rather than from a detrusor (bladder muscle) overactivity.

Urge incontinence, which comes from detrusor overactivity, is managed with medications or behavioral therapies rather than a sling. Overflow incontinence due to bladder outlet obstruction involves issues with drainage or obstruction, not urethral support, so a sling isn’t the remedy. Mixed incontinence with no predominant type may require addressing both components, since a sling alone targets the stress component most specifically.