Complications can include infection, bleeding, and the formation of fistulas (holes that form and are usually infected).

Midurethral Sling Procedures. Midurethral sling procedures use slings made from synthetic mesh materials that are placed midway along the urethra. This newer type of sling procedure has become more commonly used than the conventional suburethral procedure because it can be performed on an outpatient basis using minimally invasive surgical techniques and no abdominal incisions.

There are two types of midurethral slings:

• In the retropublic procedure, the surgeon makes a small vaginal incision under the urethra and then two small incisions above the pubic bone.
• The transobturator procedure uses only a vaginal incision.

Sling Procedures in Men. For some men who have prostatectomy-induced incontinence, sling procedures may be a good option. Researchers have reported an 80% success rate, the same as an artificial urinary sphincter, which is the standard surgical treatment for such patients. The sling procedure has been less effective in men who have had radiation therapy, although improved techniques are making this approach useful even for these patients. Minimally invasive procedures are also being tested.

Effectiveness and Complications. The sling procedure and the Burch colpsuspension seem to have similar success rates. Post-operative urinary problems, such as voiding problems, common urinary tract infections, and urge incontinence may occur. The FDA has reported complications associated with some synthetic mesh slings.

Retropubic Colposuspension (Burch Colposuspension)

Retropubic colposuspension aims to correct the position of the bladder and urethra by sewing the bladder neck and urethra directly to the surrounding pelvic bone or nearby structures. There are many variants, but, in general, they are effective only for women with urethral hypermobility. Most procedures require a general or spinal anesthetic and a 2-day hospital stay.

Burch colposuspension is the standard approach. (Marshall-Marchetti Krantz [MMK] is an alternative approach.) It is often performed during abdominal surgeries such as hysterectomy or hernia operations. It is also performed along with sacrocolpopexy, a surgical procedure used to repair pelvic organ prolapse. (Pelvic organ prolapse occurs when the uterus or bladder slips from the pelvic cavity into the vagina. It is often due to pelvic muscle weakness that develops after childbirth.) Prolapse can lead to stress incontinence. However, prolapse surgery itself sometimes causes incontinence.

The Burch colposuspension procedure may be performed using open surgery or laparoscopy. The surgeon makes an abdominal incision and secures the urethra and bladder neck with lateral (sideways) sutures that pass through thick bands of muscle tissue running along the pubic bones.

Click the icon to see an illustrated series detailing bladder neck surgery.

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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.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)