Sling Procedures Patients with severe stress incontinence and intrinsic sphincter deficiency may be candidates for a sling procedure. The goal of this treatment is to create sufficient urethral compression to achieve bladder control.
There are two techniques:
- percutaneous, which requires a small abdominal incision, and
- transvaginal, which is performed through the vagina.
Percutaneous slings The pubovaginal sling is made of a strip of tissue from the patient's abdominal fascia (fibrous tissue). A synthetic sling may be used, but urethral tissue erosion commonly occurs.
An incision is made above the pubic bone, and a strip of abdominal fascia (the sling) is removed. Another incision is made in the vaginal wall, through which the sling is grasped and adjusted around the bladder neck. The sling is secured by two sutures loosely tied to each other above the pubic bone incision, providing a hammock to support the bladder neck.
After this procedure, patients generally regain bladder control for more than 10 years. Possible complications include accidental bladder injury, infection, and prolonged urinary retention, which may require chronic intermittent self-catheterization.
Transvaginal slings Precision Tack; Transvaginal Anchor System is a device that restores urinary function by returning the urinary anatomy to its proper position in a minimally invasive procedure.
No abdominal incision is required and a small incision is made in the vaginal wall. Two small tacks are placed in the pubic bone and a sling is inserted into the vagina and attached to the tacks with sutures. The sling supports the bladder, bladder neck, urethra, and urethral sphincter so urine can flow and be held properly.
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