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Evolution of midurethral and other mesh slings – a critical analysis§


  • Peter Petros,

    Corresponding author
    1. Academic Dept of Urology, Case Western University, Cleveland, Ohio
    2. UNSW St Vincent's Clinical School, Sydney, NSW, Australia
    • Academic Dept of Urology, Case Western University, Cleveland, OH.
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  • John Papadimitriou

    1. Department of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
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  • Conflict of Interest: Peter Petros is the co-inventor of the midurethral sling (“TVT” 1995) the posterior sling “Infracoccygeal Sacropexy” 1997) and the TFS tensioned sling (2005). John Papadimitriou author has no conflict of interest.

  • Heinz Koelbl led the peer-review process as the Associate Editor responsible for the paper.

  • §

    Peter Petros and John Papadimitriou contributed to the conceptualization and writing of the manuscript.


We analyzed our original experimental studies on which the midurethral sling was based with reference to FDA mesh warnings.

We concluded that

  • 1.Vascular/organ damage could be avoided by first penetrating the urogenital diaphragm.
  • 2.A non-stretch tape minimizes obstruction and urethral damage.
  • 3.A non-obstructive musculoelastic mechanism closes the urethra.
  • 4.The strength of neocollagen (>92.8 lbs/sq inch) indicates that little mesh is required for prolapse repair.
  • 5.Foreign body (mesh) reaction is different from infection and is related to volume implanted
  • 6.Urgency is potentially curable by repairing the suspensory ligaments
  • 7.“Minislings” are promising for incontinence and POP, but more development is required.

Neurourol. Urodynam. 32: 399–406, 2013. © 2012 Wiley Periodicals, Inc.