Pubovaginal Sling with Abdominal Fascia

There are several approaches that can be used for the treatment of stress urinary incontinence. Stress urinary incontinence (SUI) is the leakage of urine with physical stressors, such as coughing, sneezing, laughing or with exercise, causing abdominal pressure to increase. When leakage is minimal and not disruptive to activities of daily living, patients may be satisfied with relief from kegel exercise or pelvic floor physical therapy. The gold standard of treatment for SUI is a mid-urethral sling, often using a polypropylene mesh to provide support to the urethra preventing the unwanted leakage. In cases where a mid-urethral sling has failed, the patient prefers a mesh-free procedure or when the vaginal tissue has thinned out to the degree that a mesh sling is not recommended, a pubovaginal sling with abdominal fascia is a great alternative. For this procedure, a small incision is made above the pubic bone (similar to a caesarian section incision) and a strip of fascia is harvested from the patient’s abdominal wall. Next, a small incision is made in the vagina where the urethra is identified and mobilized. The patient’s fascia is placed around the urethra and tensioned to provide support to the mobilized urethra. The terminal ends of the fascial strip are passed into the retropubic space (behind the pubic bone) and advanced back to the abdominal incision where they are sutured to the edge of the opened abdominal fascia. The abdominal incision and the small incision in the vagina are closed with absorbable sutures. The fascial graft provides a permanent support to the urethra to treat and prevent stress urinary incontinence. The procedure takes about 90 minutes and patients typically go home the same day or the day after surgery. If the sling is performed in combination with a vaginal prolapse repair or sacrocolpopexy, patients will stay in the hospital overnight and usually go home on post op day one. Restrictions after surgery include vaginal rest for 6 weeks to allow the incision to heal and no heavy lifting or vigorous exercise for the first 2 weeks following surgery.