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New Sling Implant Helps Women With Incontinence

Made of two synthetic threads and a tiny piece of mesh, the sling implant works like a hammock to support the bladder neck and control leakage.

Accurate Tension Adjustment Yields Better Results

A new procedure that uses a small, adjustable sling to support the bladder neck and control leakage is providing relief to women with stress urinary incontinence.

The sling implant is the latest in minimally invasive incontinence procedures performed by urogynecologists at Mayo Clinic who say that it offers the potential for better results over other therapies for two reasons. Optimal leakage control is possible because the sling tension is adjusted after the procedure while the patient is awake and can recreate the activities (bearing down, coughing) that cause her to leak. Secondly, the sling tension can be readjusted months or years later without undergoing additional surgery.

Dr. Paul Petti, a Mayo Clinic urogynecologist and editor of the book "Mayo Clinic on Managing Incontinence", says the ability to adjust the sling after the procedure takes the guesswork out of setting the proper tension during a standard sling operation. "The next morning we let the bladder fill, and we can tighten the sling tension one way or loosen it the other way," Pettit says. "We have patients cough and strain, and if they are still leaking, we can tighten it, or if they're in retention — they can't empty their bladder — we can loosen it."

Stress urinary incontinence is the leaking of urine caused by coughing, laughing, exercising or any activity that exerts pressure on the bladder. The urinary sphincter muscle at the base of the bladder may not close completely or may open inappropriately under pressure. Or the bladder and urethra (the tube that drains the bladder) may shift downward in response to increased abdominal pressure, and urine leaks because weakened pelvic floor muscles don't provide enough support for the bladder.

Urinary incontinence is particularly common in women who have had children, since pregnancy and childbirth tend to weaken the pelvic floor muscles. An estimated 10 to 30 percent of women between 15 and 64 years of age have urinary incontinence.

The sling implant takes about an hour to put in and is done under regional or local anesthesia. It may be an outpatient procedure or involve an overnight stay in the hospital. The surgeon makes a small vaginal incision to insert the sling, which acts like a hammock, and positions it to support the neck of the bladder. Another small incision is then made in the lower abdomen to draw the threads up and tie them to a tensioning device.

The tensioning device is a little bigger than a grape, and remains implanted under the skin in the fatty tissue over the pubic bone. The surgeon leaves a tiny opening in the pubic incision for a special tool that is used to adjust the tension of the sling the next morning. The tool is then discarded, and the opening closed. The patient can have the tension readjusted, if necessary, in the surgeon's office.

"The adjustable sling procedure may be the best option for women who've had other surgical procedures to treat incontinence without satisfactory results," says Pettit, "as well as for patients whose cases might cause difficulty with setting optimal sling tension during surgery."

Factors Affecting Urinary Incontinence

Stress urinary incontinence usually isn't caused by a single event. Instead, it's usually a combination of factors developing over many years. Factors include:

• Gender
• Genetics
• Vaginal birth trauma
• Previous pelvic/vaginal surgery
• Radiation therapy
• Menopause
• Chronic conditions: respiratory ailments, obesity, constipation, occupation/lifestyle (strenuous lifting)

- American Urogynecologic Society

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