Sub-urethral Sling. Stress urinary incontinence (SUI) is an involuntary spurt-like loss of urine due to a sudden increase in abdominal pressure.It is often provoked by sneezing, coughing, laughing, exercising, changing position, ect. Underlying contributing factors include childbirth (in particular, traumatic vaginal deliberies of large babies), menopause, hysterectomy, aging and any condition causing a chronic increase in abdominal pressure such as cough, asthma, and constiation. SUI is usually due to a combination of intrinsic and extrinsic causes. The intrinsic factor, intrinsic sphincteric deficiency, is a weakness of the urethral sphincter muscles. The extrinsic factor, urethral hypermobility, is an acquired laxity in the tissue support of the urethra that allows urethral descent with increases in abdominal pressure. The goal of surgical management of SUI is to provide support to the urethra in order to correct the intrinsic and extrinsic deficiencies. There are many variations on surgical techniques to provide sub-urethral support to sure SUI. The surgical treatment of SUI has evolved significantly over the past several decades. The current procedure represents an evolution of surgical technique that has merit because of its effectiveness, durability, relative simplicity, and need for only tiny incisions.
90% cure of stress urinary incontinence. 65% of patients with pre-existing urgency incontinence that accompanies the stress urinary incontinence will have resolution of the urgency incontinence.
Failure of the procedure to cure the SUI in 10%. New onset of urgency incontinence in 5-10%. Urgency incontinence is a sudden urge to urinate with the inability to make it to the bathroom on time. If this occurs, it can be treated wtih a bladder relaxant medication. Prolonged time before resumption of spontaneous voiding in 2.5%. Inability to urinate in less than 1% requiring self-catherization or takedown/revision of the sling. Injury to the urethra, bladder, bowel, or vascular structures: extremely rare. Protrusion of sling material: extremely rare.