The mechanism of urinary control and operations of synthetic sling

Background: Over the past two decades, synthetic loop surgeries have gained widespread popularity due to their ease of implementation, relatively high efficiency and low cost in the treatment of women with stress urinary incontinence (SUI). To date, several dozen variants of minimally invasive surgical procedures are known, but none of the known methods provides a 100% reliable result. At the same time, the effectiveness of the performed operation to eliminate involuntary loss of urine is inexorably reduced in the follow-up.Aims of the study. On the basis of a neuroregulatory theory published in 2019 and according to a neurophysiological model, provide an explanation for both the mechanism of urinary retention and the role of the tape implanted under the urethra in its recovery.Material and methods. Analysis of a large number of foreign and domestic literary sources, the results of clinical observations of surgery using the original author's version of the trocar synthetic sling (TSS) for 19 years, the data of the original method of uroflowmetric monitoring.Results. Taking into account the created and published theoretical basis, an explanation is presented for the effect of increasing the tone of the pelvic floor muscles in women with urinary incontinence after surgical correction using modern synthetic materials.Conclusions. The restoration of the mechanism of urinary retention in women after the operation of a synthetic sling occurs under the condition of activation of the 4th mictional reflex. In the event of a violation of the components of this reflex, the effectiveness of the sling procedure decreases and a recurrent form of the disease occurs, regardless of the type and volume of the operation used. The presence of a theoretical basis that explains both the mechanism of urinary retention itself and the pathogenesis of the development of the disease allows us to offer options for conservative therapy to prepare for the sling procedure and thereby increase the follow-up efficiency of any loop surgery.