The Evolution of Mid-Urethral Sling (MUS) Techniques
There are two primary surgical approaches for placing a vaginal sling in 2026, distinguished by the path the needle takes to position the mesh.
Retropubic Approach (TVT): The sling is passed upward behind the pubic bone and exits through two tiny incisions in the lower abdomen. This is often preferred for patients with high-degree mobility of the urethra.
Transobturator Approach (TOT): The sling is passed through the obturator membranes in the groin area. This approach avoids the retropubic space (the area behind the pubic bone), reducing the risk of bladder or bowel injury, though it may be associated with different types of postoperative hip or groin discomfort.
In both methods, the "tension-free" principle is critical: the sling is not tied or sutured into place but is held by the friction of the surrounding tissues until the body's natural collagen grows through the mesh.