In situ vaginal wall sling

Introduction. Recent reviews have noted failures of transvaginal surgical p rocedures designed to cure female stress urinary incontinence (SUI). Slings for SUI appear to sustain continence over time but have been reserved for the more complex cases of intrinsic sphincteric deficiency because of the p erception by many surgeons of increased technical difficulty and complicati on rates. However, this very success in complex cases of SUI bespeaks the n eed to develop modifications to simplify sling surgery so as to encourage s ling use in all women with SUI. Modifications continue to be applied, inclu ding anchoring the supporting sutures to the pelvic bones and reducing the transvaginal dissection to prevent further prolapse. I review the use of th e in situ anterior vaginal wall sling using bone anchoring techniques with preservation of the endopelvic fascia. Technical Considerations. The in situ sling is performed with the patient i n the dorsal lithotomy position under regional or general anesthesia, with a 16F Foley catheter placed in the bladder and a weighted vaginal speculum on the posterior vaginal wall. An anterior vaginal suburethral patch is sup ported by nonabsorbable sutures anchored to the pubic bone. Conclusions. The use of bone anchoring techniques with preservation of the endopelvic fascia appears to enhance the success rate of autologous vaginal wall slings without increasing the risk to the patient and, as minimally i nvasive procedures, these techniques appear to reduce surgical time and len gth of hospitalization, thus reducing costs. UROLOGY 56: 499-503, 2000. (C) 2000, Elsevier Science Inc.