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Also known as
Tension-free vaginal tape procedure, TVT, Mid-urethral sling, Suburethral sling
Definition
During a retropubic sling procedure, a surgeon makes a small cut in the vagina and uses a needle to pass each end of the sling from the vagina to the abdomen. The sling is held in place by the soft tissue along its path.¹
Clinical Context
Retropubic slings are a common surgical treatment for stress urinary incontinence (SUI), a condition characterized by involuntary urine leakage during activities that increase abdominal pressure, such as coughing, sneezing, or exercising [2, 3]. This procedure is primarily recommended for women with moderate to severe SUI who have not responded to conservative treatments [2].
Patient Selection Criteria: Patients considered for retropubic sling procedures typically include those with bothersome SUI, often confirmed by urodynamic studies. Factors such as age, overall health, and previous pelvic surgeries are also taken into account. It is crucial to differentiate SUI from other types of incontinence, such as urge incontinence, as the sling procedure is specifically designed to address SUI [1].
Surgical Procedures: The retropubic sling procedure involves placing a synthetic mesh or autologous (patient’s own) tissue sling under the mid-urethra. The ends of the sling are then passed through the retropubic space (the space behind the pubic bone) and secured. This creates a supportive hammock-like structure that provides support to the urethra and helps prevent urine leakage during increased abdominal pressure [1, 2]. The procedure is typically performed through a small vaginal incision and two small suprapubic incisions [1].
Expected Outcomes: Retropubic slings have demonstrated high success rates in treating SUI, with many studies reporting significant improvement or cure rates [1, 2]. Patients often experience immediate relief from SUI symptoms post-surgery. Potential outcomes and recovery timelines vary, but most patients can resume normal activities within a few weeks. Long-term efficacy and patient satisfaction are generally favorable, though potential complications, such as mesh erosion, urinary retention, or de novo urgency, are discussed with patients prior to surgery [1, 2, 3].