The Urology Center Glossary terms

Sling Procedure (Female):

Without question, the greatest advancement in the treatment of stress urinary incontinence has been the ... "sling" procedure.

Without question, the greatest advancement in the treatment of stress urinary incontinence has been the development of pubovaginal sling surgery, or simply a "sling" procedure. Sling surgery involves placement of strong sling material beneath the urethra which is suspended from above, behind the pubic bone. The sling material functions somewhat like a hammock within which the urethra rests. The goal of the surgery is to support the urethra and bladder neck to produce support and closure of the urethra, preventing leakage of urine during physically stressful activities such as coughing, sneezing, lifting, straining, standing, walking and the like.

The sling procedure has been proven to be as effective, if not more effective, than any other form of treatment.

The sling procedure has been proven to be as effective, if not more effective, than any other form of treatment. While the first sling procedures were performed in the early 1900s, progressive improvements have been made. Even as late as the 1990s, the procedure was more invasive and more complex than is presently the case. In the 1990s most urologists did not perform sling surgery because of the popularity of other "easy to perform" surgeries which were subsequently shown to be inadequate to stop incontinence in many patients. As previously discussed, these outdated surgeries include such procedures as the so-called "bladder tack surgery", "bladder neck suspension surgery", "Raz", "Stamey", "Pereyra", "Kelly plication" and others. Doctors were eager to perform the less involved (but ultimately inadequate) surgeries. Furthermore, since many surgeons were unfamiliar with how to perform the sling procedure, they were logically apprehensive about possibly causing complications. As time when on, these easy to perform procedures began to fail, especially in active women and in overweight women. Additionally, surgeons did not clearly understand under which circumstances a sling should be performed. That is, they did not know for which patients the procedure was best suited.

In the early 1980s and 1990s a urologist in Houston, Texas popularized sling surgery by defining the patient population in which it should be performed. He used bladder pressure (urodynamic) testing to demonstrate the effectiveness of this technique under certain well defined conditions. Other urologists modified the technique but until the late 1990s the sling procedure still required surgical incisions of both the vagina and the skin of the lower abdomen. Furthermore, the substance used for the sling material itself had to be harvested from the patient. This sometimes required additional skin incisions or a total of three surgical incisions.

In the late 1990s materials and equipment were developed which made the pubovaginal sling procedure less invasive, faster and much easier to perform. These developments popularized the sling procedure with physicians who were previously uncomfortable performing such involved surgery. Since then, the sling procedure has become widely available. Even much less experienced physicians now perform the procedure.

"Dr. Watson has been performing sling procedures throughout the 1990's and ... 2000's. ... Skin incisions are rarely if ever necessary."

Dr. Watson has been performing pubovaginal sling procedures throughout the 1990s and into the 2000s. He is familiar with nearly every technique, new or old. He was the first physician in the local area to perform these procedures and he continues to perform sling procedures on a regular basis with excellent results. Over about the last three years, the procedure has been performed on strictly an outpatient basis. The procedure is performed in the operating room at either a hospital or at an outpatient surgery center. Most patients opt to undergo a general anesthetic and they experience no pain during the procedure. Skin incisions (other than inside the vagina) are rarely if ever necessary. Only a small opening in the lining of the vagina is used. It is no longer necessary to harvest sling material from the patient, thus preventing the need to make extra incisions. Other non-synthetic sling materials are now readily available.

Before having the sling procedure, always ask your doctor to be certain what material he or she plans to use.

Despite the fact the some clinical studies have demonstrated short-term safety of the use of synthetic polypropylene (Prolene) mesh, many urologic surgeons are concerned that synthetic materials such as this should not be used as sling material for fear of significant complications. Although the urologic surgeons of the Urology Center do not routinely use Prolene mesh, patients should be aware that other urologists are regularly using this material during surgery. Before having the sling procedure, always ask your doctor to be certain what material he or she plans to use.

Postoperatively, patients are observed in the hospital for several hours after which the bladder catheter is removed and patients urinate. Approximately ninety percent of patients urinate successfully and are discharged home several hours after surgery. At such time patients are urinating but no longer accidentally leaking urine with coughing, sneezing or similar physically stressful moves. Stress urinary incontinence is almost always cured. Ninety-five percent of patients no longer have stress urinary incontinence. A small percentage of patients require use of a temporary catheter. A minority of patients do experience urge type incontinence which is generally alleviated by using medications such as Ditropan or Detrol along with behavioral techniques.

We are very proud to offer this highly effective but minimally invasive, contemporary [sling] procedure which has helped so many women with the chronic problem of unwanted urinary leakage.

The vast majority of patients undergoing the sling procedure are extremely happy to have undergone procedure to become dry. Most indicate that they experience little if any discomfort at any time after the procedure. Again, most patients are discharged to go home several hours after the procedure has been completed. Patients miss very little work or other activity because they recover so quickly. We are very proud to offer this highly effective but minimally invasive, contemporary procedure which has helped so many women with the chronic problem of unwanted urinary leakage.

(Please visit our Female Urology Center of Excellence for additional information.)