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Department of Urology
University of Washington | School of Medicine
Department of Urology

Treatments & Procedures - Surgical

Female Sling Procedure

Authored by: Jane L. Miller
Last updated: March 22, 2006

Overview

Slings (figure SPARC) are used to treat Stress Urinary Incontinence (SUI) They are not effective in treating urge incontinence. There are a wide variety of slings, including the pubovaginal sling, the midurethral retropubic slings and the transobturator slings. A sling is a piece of material 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 when they increase abdominal pressure, such as during coughing. The sling remains stationary, and comes in contact with the urethra 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). Some slings are placed at the bladder neck and others at the midurethral. . Some slings are secured to the anterior abdominal wall fascia, or to the undersurface of the pubic bone. Other slings are not anchored. In the past 5 years, 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. Secondingly, 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, urge incontinence.

Medications

There are no medications approved to treat SUI. You may ask your doctor about Symbalta (duloxetine).

Considerations

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

Effectiveness

THe midurethral slings are produce cure (leakage never or rarely) in 85% of patients, an additional 10% are significantly better, and 5% are unimproved.

Risk

What are the risks involved with this treatment/procedure?

The risks of slings are injuring to the bladder, urethra, bowel, pelvic vessels. Urinary retention (inability to void) urgency, urge incontinence, and vaginal sling extrusion. The most commonly reported complication is bladder injury, 5-15%, and vaginal sling extrusion (6%). The other complications are rare. If you are considering having a sling procedure, please discuss these potential problems with your surgeon.

What are the risks of not having this treatment/procedure?

None.

Urgency

None

Related Treatments

Retropubic Bladder Neck Suspension, Periurethral Bulking Agent, Pelvic Floor PT, Pessary, Urethral Plug

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Call (206) 731-3241

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