Surgical management of stress urinary incontinence in women: Bladder neck fascial sling procedures
- Kimberly Kenton, MD, MS, FACOG, FACS
Kimberly Kenton, MD, MS, FACOG, FACS
- Professor, Obstetrics & Gynecology
- Chief, Female Pelvic Medicine & Reconstructive Surgery
- Northwestern University, Feinberg School of Medicine
- Chicago, IL
Surgical therapy for female stress urinary incontinence (SUI) includes bladder neck slings, midurethral slings, and Burch urethropexy (table 1).
Although the midurethral sling is the most common procedure for treatment of SUI and the standard of care for most patients, rare patients may not be candidates or may request surgical techniques that do not use synthetic mesh [1,2]. This topic reviews bladder neck (also known as suburethral or pubovaginal) fascial sling procedures. In women undergoing surgical treatment, midurethral synthetic slings are generally preferred to bladder neck fascial slings or Burch urethropexy . However, in women who decline or are not candidates for midurethral slings, bladder neck autologous fascial slings remain an effective treatment for SUI.
The evaluation, treatment and other surgical options for women with SUI are discussed elsewhere. (See "Treatment of urinary incontinence in women" and "Surgical management of stress urinary incontinence in women: Choosing a primary surgical procedure".).
ANATOMIC LOCATION AND MATERIALS
Bladder neck slings are placed at the level of the proximal urethra or bladder neck. The anterior rectus fascia (ie, pubovaginal sling) and pubic bone are the most common superior attachments for bladder neck slings; however, the superior rectus fascia is preferred as most high-quality outcome data use the rectus fascia. In addition, bone anchors, used to attach the sling to the pubic bone, are associated with osteitis pubis and osteomyelitis  and offer no improvement in outcomes.
Sling materials include autografts (rectus fascia or fascia lata), allografts (fascia lata), xenografts (porcine dermis), and synthetic meshes (mersilene or expanded polytetrafluoroethylene). We use rectus fascia harvested from the patient (autologous) at the time of the sling surgery.
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- ANATOMIC LOCATION AND MATERIALS
- MECHANISM OF ACTION
- PATIENT SELECTION
- PREOPERATIVE EVALUATION AND CONSIDERATIONS
- Antibiotic prophylaxis
- Venous thromboembolism prophylaxis
- OTHER SLING MATERIALS
- Autologous slings
- Allograft slings
- Xenograft slings
- Synthetic slings
- POSTOPERATIVE CARE
- CONTINENCE RATE
- SUMMARY AND RECOMMENDATIONS