The obturator approach to the treatment of stress incontinence offers many advantages over previous operations, especially ease of surgery, safety and good predictable cure rates. Apologists for each method have preferences that should be respected – but at the present time there is no sound clinical evidence comparing the “outside – in” to the “inside – out” transobturator approach, and this data is awaited with interest. Theory and opinion do not translate to clinical evidence. While the retropubic approach is still popular, the obturator approach has many probable advantages to recommend this technique, and make it the treatment of choice. A multitude of sling products are now available on the South African market, many being fake copy – cat counterfeits of the originators. While the ersatz knock – offs may be slightly cheaper (since no development costs were involved), the originators have the advantage of published clinical trials proving good outcomes. Fake products are seldom an improvement on the originals and must be used with caution.
Extensive use has been made of detailed reviews by Cardozo and Chapple published in the BJOG. The interested reader is urged to obtain the BJOG supplements, and obtain references from the reviews.