Surgery – Stress Urinary Incontinence
Pubovaginal Sling Procedure
A sling procedure is done to create support where the urethra connects to the bladder (a.k.a. bladder neck). A sling is especially effective for the woman who has the diagnosis of Intrinsic Sphincter Deficiency (ISD) where the sphincter muscle is ineffective at holding urine in the bladder during certain "stressful" activities such as coughing, sneezing or exercising. There are many different types of "sling" operations described in the literature. The slings differ in the type of material, sutures, and points of anchoring. The decision on the type of sling utilized is surgeon dependent. The sling is placed under the bladder neck and is secured to a point of attachment (bone, abdominal wall, and ligament) through a vaginal incision. Therefore, when the woman coughs or sneezes, the bladder does not have as much motion now that the "backboard" is in place and so she will not experience any leakage. This procedure is done in the operating room under anesthesia and the patient goes home either the same day or the following day. The most recent efficacy statistics for patients undergoing pubovaginal sling procedures is upwards of approximately 85% for patients who have had the surgery 10 years ago. A sling procedure is considered "curative" for the female patient.
Tension-Free Vaginal Tape (TVT) Sling
Dr. Miklos learned the TVT sling procedure in Stockholm, Sweden in 1998. The TVT sling procedure has been performed in Europe since 1995 with great success. Dr. Miklos was the first of four surgeons in the United States to perform the TVT sling operation and served as a preceptor to teach this operation to Urologists, Urogynecologists and Gynecologists throughout the world. In June 2000, Dr. Miklos traveled to Russia to introduce the TVT sling operation to his colleagues at the University of Moscow.
Both Drs. Miklos and Moore choose the TVT sling for their patients because the operation is/has:
- Minimally invasive (two incisions of 1/3 inch on the pubic hairline)
- Minimal pain (40% of patients will not need a pain reliever after 24 hours)
- Proven cure rate of 80-90% – 5-10 years after surgery
- Same day or next day discharge for 98% of patients
- Performed under local anesthesia and IV sedation
- Operative time 20-30 minutes
- Minimal postoperative need for catheterization
- Minimal complications
For surgical treatment information on TVT sling, click here.
Transobturator Tape (TOT) Sling
Dr. Miklos first saw the TOT sling performed in Russia in 2001 but was hesitant to do the surgery due to its unique new application and delivery to the human body. In 2002 Dr Moore traveled to Lyon France to learn the new technique. He came back and adopted the technique and trained Dr Miklos. Dr Moore is considered the first user of TOT sling in the USA today and he and Dr Miklos have been performing the procedure routinely since that time. Dr Moore and Miklos served as preceptors for years teaching the technique to surgeons throughout the world.
TOT slings offer:
- 80-90% cure rates (5-7 years after surgery)
- Less pain than TVT slings
- Less blood loss than TVT slings
- Less chance of morbidity
- Less chance of bladder injury
For surgical treatment information on TOT sling, click here.
The mini sling is a essentially a miniature sling delivered through a single incision site via the vagina. Most other slings require either two or three incisions. Both the TVT and TOT slings requires three incision sites, an incision in the vagina and two smaller exit incisions in the pubic area or the groins bilaterally. The mini sling was produced in an attempt to maintain cure rates yet minimize pain, blood loss, and voiding dysfunction post operatively. There are two main types of mini slings in circulation today: 1) Secure made by Gynecare whose cure rates average in the 60-70% range and 2) Mini ARC – made by American Medical System (AMS) whose cure rates are 90%.
For surgical treatment information on Mini Arc sling, click here.