[Indication for and methods of sling operations (author's transl)].

Sling operations are considered to be highly dependable approaches to stress incontinence. While they used to reserved primarily for recurrent incontinence, in the past, today, they often are applied as primary approach, either alone or in conjunction with uterus extirpation. The reasons underlying such change are explained by the present and past distributions of operations for incontinence at the Gyneacological Hospital of Humboldt-Universitat zu Berlin. Indications can now be established with higher accuracy due to the availability of urometry. Urge incontinence or combined stress-urge incontinence with predominance of the urge component as well as assisted detrusor micturation are contra-indications. Useful information sometimes, may be derived from the presence of uninhibited detrusor contractions provoked by means of a Foley catheter. If at least some improvement is to be achieved of predominant stress incontinence, synthetic sling material should not be used. In the context of surgical peculiarities, neck is underlined for removing cystoceles and adjusting the sling to the bladder neck region. Diazepam, alpha-receptor blocker and/or cholinergics should be used to handle postoperative disorders of micturition. Postoperative urine flow studies are of limited value. Successful micturition without residual urine is the decisive criterion by which to measure the result of a sling approach. Sling operations should be confined to large well equipped and properly staffed hospitals for the diagnostic input involved, surgical peculiarities, and risk of postoperative disorders of micturition.