Mid-Urethral Sling

Mid-Urethral Mesh Slings

Mid-urethral sling procedures are the most commonly performed SUI operation. They are safe, effective, and improve quality of life for many women. These procedures involve placing a thin piece of mesh underneath the middle part of the urethra (mid-urethra) to provide support. The graft material in this type of sling is most often made of polypropylene mesh. These procedures have been done for over 20 years with excellent results. There are three types of mid urethral slings:

• Retropubic sling: The sling sits just under the mid-urethra and exits just above the pubic bone with an incision on each side. It is also called tension free vaginal tape procedure, or TVT™, or another name depending upon the company who makes the product.
• Transobturator sling: The sling exits on each side of the groin through two small incisions. It may also be referred to as a TOT™ or Monarc™ or have another name depending upon the company who makes the product.
• Mini-Slings (Single Incision Slings): The sling requires only one incision in the vagina and self-anchors. It may also be called a MiniArc™ or have another name depending upon the company who makes the product.

Mid-urethral slings are the best-studied incontinence surgery in history. The Food and Drug Administration (FDA) supports the safety and effectiveness of this surgery. The permanent mesh used in this surgery does not cause the high rates of complications that have been in the news related to mesh used for other types of vaginal surgery.

Pubovaginal/Fascial Bladder Neck Slings

Physicians have been performing this operation for stress urinary incontinence since 1947. In this operation, the surgeon uses strong tissue called fascia underneath the urethra with the ends sutured to the tissue covering the abdominal muscles. There is a small incision in the vagina and another just above the pubic bone with this procedure.

This procedure is called a bladder neck sling because the tissue is placed at the level where the urethra meets the bladder. The tissue can come from the patient herself or from donated tissue. This procedure does not utilize mesh.

Burch or Marshall Marchetti Krantz (MMK) Colposupension

In retropubic colposuspensions (either the Burch or MMK procedures), the surgeon places stitches into the vaginal wall alongside the urethra at the bladder neck and then secured to ligaments nearby in the pelvis (Cooper’s ligament) or into the strong tissue that covers the back of the pubic bone. The stitches lift the vaginal wall that the urethra rests upon and provides support to the bladder neck and urethra. This procedure is done very infrequently and does not utilize mesh.