Single-incision short sling mesh insertion for stress urinary incontinence in women

3 The procedure

3.1 Single-incision short sling mesh insertion aims to reduce the risk of urinary leakage in women with stress urinary incontinence. It is considered when conservative options (see section 2.2) have been tried but incontinence persists. The procedure aims to minimise the risk of major adverse events such as bladder, vaginal, urethral and vascular perforations or erosions, and chronic pain that are associated with minimally-invasive sling procedures. The single-incision short slings have shorter tape lengths and different fixation systems to transobturator minimally-invasive slings. These fixation systems do not enter the retropubic space (minimising the risk of major vessel or visceral injury) or the lateral half of the obturator foramen (potentially reducing the risk of groin pain), but they are anchored in the obturator membrane or in the obturator muscles.

3.2 With the patient under local (with or without sedation), regional or general anaesthesia, a small incision is made in the vaginal wall, under the urethra. The sling, which is typically 8–14 cm long, is inserted using a delivery needle through the obturator foramen and retracted to deploy the sling into the obturator internus muscle. This is repeated with a second sling on the contralateral side. A special tip anchors the sling in place behind the mid urethra. Sling tension is then controlled using the delivery device until the appropriate tension is achieved. The delivery device is then removed and the incision is closed. The slings are permanent implants. Cystoscopy is used to check that bladder perforation has not occurred during the procedure.

3.3 Single-incision short sling systems may differ in the length of the sling, the fixation method, the fixation location and the method of tension adjustment or control.