Mid-urethral slings

In a review article on mid-urethral slings (O&G Magazine Vol 16 No 4 Summer 2014 p.45), Dr Tucker states that credit for their introduction is often given to Ulmsten and Petros, which I believe to be correct; however, he then states that it could be argued the original innovators were Raz and Stamey. I believe Dr Tucker is incorrect in this statement: both Stamey and Raz, as I understand their original descriptions of their surgical procedures, were aiming at bladder neck elevation by the transvaginal approach and not mid-urethral elevation. It is the work of Petros and the late Ulmsten that transferred attention from the bladder neck area to the mid-urethra and which has led to such dramatic advances in the treatment of urinary stress incontinence, since that concept was described by them. They deserve the credit for the operation that has cured stress incontinence in nearly two million women worldwide.

In addition, Dr Tucker states that he has no conflict of interest to declare in writing a review article that assesses numerous urogynaecological prostheses, but as an appointee to the Urogenital Prosthesis Clinical Advisory Group of the Australian Federal Government Department of Health I believe this does indeed constitute a conflict of interest or of potential bias. Perhaps more importantly, Dr Tucker also states he is a Member of the International Advisory Board for Boston Scientific, a large manufacturer of gynaecological prostheses. This company is currently the subject of a large medico-legal claim not dissimilar to that which has just been settled by American Surgical for close to a billion dollars. It is incongruous to say that this does not constitute a conflict of interest when writing a review article.

Author’s response

Dr Ashton’s comments are relevant and deserving of a response and I thank him for his interest in the article. Firstly, by the mid 1980s, many gynaecologists, including myself, were attaching the ‘Stamey’ suspension sutures to the paraurethral fascia in the region of the mid-urethra – not as high as the bladder neck, to facilitate passage of the needle and minimise the risk of bladder trauma.

Secondly, my appointment with the Urogenital Prosthesis Clinical Advisory Group is totally unbiased and devoid of conflict of interest. In no way has this appointment influenced the published article. Importantly, within such committees, very rigid guidelines are in place to enforce this situation and ensure that no conflict of interest can bias, potentially or directly, the decisions of the committee.

Thirdly, my involvement with Boston Scientific has been on the Advisory Board for development of their neuromodulation system for sacral nerve stimulation. It is not associated in any way with the Boston Scientific mesh/tape prostheses. I also work with Medtronic (unpaid) to improve and advance the Medtronic sacral nerve neuromodulation system.

Dr Ian Tucker
MBBS, FRANZCOG, FRCOG, CU