Teaching module for three midurethral sling complications Knowledge of urethral closure/opening mechanisms and pathogenesis of SUI informs management of “difficult” cases

We begin this teaching module with a short summary of the mechanism of urethral closure as originally presented in the 1990 “Integral Theory of Female Urinary Incontinence”, the relative roles of muscles and ligaments, how they coordinate to effect urethral closure and evacuation and then relate how these mechanisms impact on surgical technique. Following this, we present three different clinical problems. We have invited comments from surgeons from the International Society of Pelviperineology who are experienced experts in the midurethral sling as to how they would manage these problems.