Fascial Sling

Sling procedures are used to prevent urinary incontinence. They are performed through a vaginal incision and are designed to create a hammock effect of either tissue or mesh under the urethral valve area to prevent urine leakage with activities. The traditional fascial sling procedure uses a strip of your own tissue (called "fascia") to create the hammock of support under the bladder neck. The surgeon attaches both ends of the sling to the pubic bone or ties them in front of the abdomen just above the pubic bone through a small incision.

Midurethral Slings

Midurethral slings are newer procedures (first described in 1996) for the treatment of urinary incontinence that you can have on an outpatient basis. There are two types of midurethral sling procedures, the retropubic sling and the transobturator sling.The main difference is the retropubic sling travels behind the pubic bone and are more of a U shape where the trans obturator slings exit through the groin crease near the thigh and are more "smile" shaped. The surgeon makes a ½ inch incision in the vagina, and uses specially designed needles to position a synthetic mesh tape under the urethra. These needles are placed through small 1/8 inch incisions either behind the pubic bone or in the groin crease area. The surgeon pulls the ends of the tape through the incisions and adjusts them to provide the right amount of support to the urethra. Click here for instructions in the peri-operative period for a midurethral sling.

No one knows at this time whether the retropubic or transobturator sling is better. There is a large research study that is ongoing to try to answer this question. However, we will not have results of the large study for several years. Our clinical experience is that patients do well with both types of sling. Until we have more data, your doctor will look at how severe your leakage is, how much urgency symptoms you have, as well as other issues to determine the best type of sling for you.

- The midurethral "sling" is a permanent polypropylene mesh which supports the urethra to minimize movement during stressful activities (coughing, sneezing, exercising) and prevent incontinence.

- The procedure is a 15-30 minute, outpatient procedure.

- The sling is placed through a small ½ inch vaginal incision and there are 2 small 1/8 inch exit wounds either in the groin or suprapubic area.