Pubovaginal Sling

Stress incontinence is the most common kind of urinary incontinence in women. It is the term used for leakage of urine during exercise, coughing, sneezing, laughing, or lifting.

The pelvic floor muscles normally fit snugly around the neck of the bladder. They form a ring of muscle that prevents urine from escaping through the urethra, which is the tube that carries urine out of the bladder. However, the pelvic floor muscles can be stretched or torn during childbearing. There may also be further loss of muscle tone after menopause due to a thinning of tissues caused by a lack of estrogen. Sudden pressure on the bladder (for example, from coughing or sneezing) can overcome the weakened muscles and cause a little urine to escape. Diabetes, obesity, and urinary tract infections also contribute to stress incontinence.

A Pubovaginal Sling is the “gold standard” operation for Stress Incontinence.  It is placed through a small incision in the vagina and two small puncture incisions in the skin over the pubic bone that will be used to place a strap of synthetic mesh underneath the bladder neck like a hammock to prevent leakage with increases in abdominal pressure that occurs with cough, sneeze, and exercise.  Once the sling has been placed, a small scope is used to look into the bladder to make sure there has not been a bladder injury during the sling placement. The bladder is then filled and the tension on the sling is adjusted. The key to the surgery is having the sling snug enough to prevent leakage, but loose enough to not interfere with bladder emptying. The alternatives to surgery including using a pessary and pelvic floor physical therapy.  Urethral bulking is also an option if you have good urethral support and/or low urethral pressures.

vaginal sling

Benefits:

  • Success rate of the sling surgery is 90-95% if this is your first surgery for stress incontinence. The success rate is slightly lower at 80-85% if you have had prior surgery and/or you have low urethral pressures which are suggestive of a weak sphincter mechanism.
  • utpatient, minimally invasive procedure
  • Most patients are “dry” immediately and are back to nonstrenuous activities in a few days

Risks:

  • Bladder perforation, voiding difficulty, persistent leakage, mesh exposure, and urinary tract infection.

Call Peachtree Gynecology  today at 678-539-5980 at to see if this is the right option for YOU!