Table of Contents
There are nearly 200 surgical procedures for incontinence. Most are designed to restore the bladder neck and urethra to their anatomically correct positions in patients with stress incontinence. Injections of bulking materials are another option for women and men.
The choice of surgical procedure depends on a number of factors, including the presence of bladder or uterine prolapse, the severity of incontinence, and the surgeon’s experience in performing specific types of surgery.
In general, patients should weigh all options carefully. They should discuss the situation with their doctor, and ask about their surgeon's experience. They should also be completely informed about the benefits and risks of the procedures. Patients will need to have a complete diagnostic evaluation before any surgical procedure, including assessment of post-void residual urine volume.
A sling procedure is usually the first-line surgical approach for stress incontinence in women who have either intrinsic sphincter deficiency or urethral hypermobility. It may also be useful for managing female urge incontinence. Sling procedures are also available for men who experience incontinence after prostatectomy.
The purpose of a sling procedure is to create a sling or hammock around the neck of the bladder to help keep the urethra closed. There are different types of sling procedures. They include:
- Suburethral, which is the traditional type
- Midurethral, which includes retropublic transvaginal tape (TVT) and transobturator tape (TOT)
Suburethral Sling Procedure. The suburethral, also called pubovaginal, sling is the traditional sling procedure. It uses a sling made from the patient’s own tissue (fascia), animal tissue, or a synthetic material. Suburethral means “beneath the urethra”. The procedure may be performed with laparoscopic or conventional “open” surgery. The procedure generally works as follows:
- The surgeon makes an incision above the pubic bone and removes a layer of abdominal fasci (tissue that covers muscle fibers). This muscle strip is set aside and later serves as the sling.
- The surgeon makes an incision in the vaginal wall. The piece of muscle fiber or material is attached under the urethra and bladder neck, somewhat like a hammock, and secured to the abdominal wall and pelvic bone.
- This sling then compresses the urethra back to its original position. The sling must be supportive without being too tense, which can cause urinary obstruction.
Review Date: 07/26/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.