Slings
This is a minimally invasive procedure that uses a small, thin mesh or “tape” to create a “hammock” effect under the urethra. This can be approached via the pubic symphysis or the obturator area. It is important to note that after careful data analysis, the FDA has stated that there is a low to modest risk with these “tape” type procedures. The mid-urethral sling has excellent long-term data and a high success rate, that is between 80-90%.
Non-Mesh Option
If a patient is opposed to mesh or cannot have the type of procedure for other reasons, there are other options available.
The Burch procedure is done to support the hypermobile urethra that causes stress urinary incontinence. It can be done with a very small “bikini” incision or robotically. Sutures, not mesh, are used to support the urethra and bladder neck.
The fascial sling procedure uses the patient’s own tissue or fascia as the “tape”. No mesh is used for this procedure. Once again, a “bikini” incision is made where the fascia is harvested. The fascia is then fastened and placed under the urethra through a separate vaginal incision.
Both of these procedures are alternatives to the traditional mesh procedure, with good success. These procedures are slightly more invasive techniques and involve a slightly longer recovery phase.
Bulking Agents
Periurethral bulking agents are injected into the urethra and used to “plump up” the urethra to decrease or eradicate stress urinary incontinence. The procedure can be done under light anesthesia or even in the office. The bulking agents are effective for mild stress urinary incontinence and for women who have the diagnosis of ISD (intrinsic sphincter deficiency), where the urethra does not close completely. These are several FDA approved agents that are used and although they are effective for stress urinary incontinence, repeat procedures may be necessary.