According to a 2008 study in the Journal of the American Medical Association, 15.7 percent of American women suffer from some form of urinary incontinence. Bladder sling procedures are used to treat stress incontinence, a condition in which coughing, laughing or sneezing causes people to leak urine. There are three common types of bladder sling surgery.
Pubovaginal Sling
Considered the gold standard of incontinence surgery, the pubovaginal sling is a procedure in which connective tissue from a cadaver or the patient's own abdominal muscles, or polypropylene mesh are used to create a sling to cradle the bladder. On one end, the sling is secured to the neck of the bladder. On the other, the sling might be attached to the pubic bone or to connective tissue just above the abdomen. Bone-anchored slings are considered more durable, but carry the risk of infection of the bone (osteomyelitis), which can be difficult to treat.
TVT Sling
A TVT (transvaginal tape) sling provides support to the urethra, rather than the bladder. In a minimally invasive procedure, this kind of sling introduces human tissue or synthetic mesh "tape" into the body through a small incision in the vagina. Then, it is looped behind the urethra. Each end of the tape is caught by one of two needles introduced through small incisions just above the pubic bone and raised towards the area between the bladder and the pubic bone.
A TVT sling is considered "tension-free" because no sutures are used to secure the tape. Initially, friction created between the tape and the patient's tissue will support the tape. Later, scar tissue will add additional support. TVT sling surgery can be performed under local anesthesia, allowing for adjustment and reducing the incidence of one of the most common complications, postoperative voiding difficulty. However, because the needles can't be seen by the surgeon as they are advanced, there is a low, but significant risk of injury to the bladder or surrounding blood vessels.
TOT Sling
The TOT, or transobturator tape sling, was developed as a refinement to the TVT in which tape is passed through the obturator foramen, a bony loophole in the pelvis. As with the TVT sling, three small incisions are used, including one in the vagina.
The other two incisions are in the groin. The TOT offers a shorter operative time (20 minutes) and a somewhat lower complication rate, compared with the TVT sling. However, the TVT sling is more effective in women with intrinsic sphincter deficiency, a condition in which the sphincter muscle is weakened or deteriorated.
References
- NIH National Kidney and Urologic Diseases Clearinghouse
- Journal of the American Medical Association. Prevalence of symptomatic pelvic floor disorders in US women.Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, Spino C, Whitehead WE, Wu J, Brody DJ; Pelvic Floor Disorders Network. September 17, 2008.
- Current Opinions in Obstetrics and Gynecology. Comparison of tension-free vaginal tape and transobturator tape procedure for the treatment of stress urinary incontinence. Long CY, Hsu CS, Wu MP, Liu CM, Wang TN, Tsai EM. August 2009.
