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Department of Urology

Sling Procedures for Incontinence

Overview

Slings  are used to treat activity-related or Stress Urinary Incontinence (SUI) There are a wide variety of slings, including the pubovaginal sling, the midurethral retropubic slings, the transobturator slings and “mini-incision” slings.  A sling is a piece of material, usually a synthetic mesh, that is placed beneath the urethra to support and compress the urethra during activity. Most women with SUI have movement of their urethra away from the pubic bone (hypermobility) when they increase abdominal pressure, such as during coughing. The sling remains stationary, and the urethra comes in contact with the sling during its downward movement, essentially compressing it. It can be likened to stepping on a hose with running water and shutting the stream off. Slings were described many years ago, and have recently been modified such that they can now be placed as outpatient procedures, and are minimally invasive. The sling materials vary: autologous (or patients own) fascia, cadaveric fascia (harvested from a cadaver), synthetic material (polypropylene mesh), though synthetic mesh is most commonly used today. Today many urologists are using a synthetic sling that is place transvaginally through small incisions. These slings are called midurethral slings and have several advantages. First, they are minimally invasive and can be done as outpatient procedures. Secondly, they are durable because the snythetic material is strong and inert. Finally, they are associated with fewer urinary symptoms such as urinary retention (or inability to void) and urinary urgency, frequency, and urge incontinence and patients can return to normal daily activities sooner.

Preoperative Considerations

Any women who is bothered by SUI, and whose symptoms persist despite pelvic floor exercises.