Vaginal sling surgery for stress urinary incontinence

Abstract

Vaginal sling procedures are indicated in the management of stress urinary incontinence secondary to both intrinsic sphincteric deficiency (ISD) and urethral hypermobility resulting in anatomical incontinence. Although we currently do not attempt to distinguish between these two entities, it remains important that a procedure help both types of incontinence. Several long-term reviews have demonstrated that pubovaginal slings are among the most versatile and durable of the surgical approaches for stress incontinence. Still, the goal remains to create a procedure that supports and compresses the urethra during an increase in intra-abdominal pressure while minimizing the attendant morbidities of the approach. Recent efforts have concentrated on using a variety of materials to help create a hammock of support for the damaged sphincteric unit. These include autologous fascia, anterior vaginal wall, dura mater, bovine pericardium, xenograft tissues, a host of synthetic meshes, and allograft tissues. It is beyond the scope of this chapter to discuss all the pros and cons of each approach because many investigators have their individual preferences. © 2006 Humana Press Inc.