|December 2002 · Vol. 14, No. 12
Treating stress urinary incontinence with suburethral slings
Recent modifications to suburethral sling procedures have brought them to the forefront of stress urinary incontinence treatment. Here, the authors review the advances and evidence on synthetic and organic slings.
Dr. Iglesia is director, female pelvic medicine and reconstructive surgery, Washington Hospital Center, Washington, DC. Dr. Canter is chief resident, department of OBG, Georgetown University Hospital
Suburethral sling procedures are effective in treating patients with urethral hypermobility, intrinsic sphincter deficiency, low-pressure urethras, and increased intra-abdominal pressure.
Autologous slings may be a better choice in cases of severe urogenital atrophy, previous radiation, or extensive scarring from previous repairs.
For both the tension-free vaginal tape and SPARC slings, mark the suprapubic region 1 cm above and 1 cm lateral to the pubic symphsis on the left and right sides and inject 20 cc of a 1:1 mixture of local anesthetic and normal saline into the marked regions.
Once the trocars are in place, fill the bladder with 250 cc of water and perform a cough stress test to confirm continence.
When the suburethral sling was first described in 1907 by von Giordano, it entailed placing autologous tissue underneath the bladder neck and suspending it superiorly. Complications including urethral erosion, infection, bleeding, and fistula formation led many surgeons to use it sparingly.
Fast forward to the 21st century: Synthetic materials and new techniques were introduced, simplifying the sling procedures and raising the long-term success rates to 84%.1 As a result, slings now stand at the forefront of stress urinary incontinence (SUI) treatment. Among advances are the tension-free vaginal tape (TVT) sling (Gynecare, a division of Ethicon Inc., Somerville, NJ) and the SPARC sling (American Medical Systems, Inc., Minnetonka, Minn). The former, approved in the U.S. in 1998, calls for another look due to of the recent publication of a Cochrane review of outcomes studies, while the latter, approved by the FDA in August 2001, is the newest technique deserving examination. Clearly, with 83,010 incontinence procedures performed in the U.S. in 1999,2 a detailed look at the suburethral sling is warranted. Here, we review materials, indications, techniques, complications, and outcomes.