What types of sling surgery are used to treat women with incontinence?

For women, two types of minimally invasive sling surgery are available. In one, the surgeon places a hammock of narrow mesh underneath the urethra (the tube that connects the bladder to the outside of the body) and extending up to the abdominal wall above the pubic bone. The mesh stays in place without sutures, as your body creates scar tissue around and through the mesh. This surgery (available in several systems with brand names such as Gynecare TVT and SPARC) is faster and easier than older, more invasive sling procedures and, in many cases, can be performed under local anesthesia with IV sedation. Some surgeons combine the placement of TVT with other pelvic reconstructive surgery, such as vaginal hysterectomy or repair of cystocele or rectocele (bladder or rectal tissues bulging into the vagina). Most women return to some activity within about 10 days but should not exercise or lift heavy objects for 6-8 weeks.

In a second minimally invasive sling procedure, transobturator tape (TOT, with brand names such as Monarc and Uratape) is inserted through a small vaginal incision and the ends are brought out through tiny incisions between the labia and the creases of the thighs. The sling supports the urethra in a gentler fashion, forming a curve shaped more like a smile than the letter U. No sutures or anchors are used. Surgery takes about half an hour, and most women can return to work within a few days if they do not have to lift heavy objects. Performed without an abdominal incision, this procedure reduces the risk of bowel or bladder injury during surgery, and it can be used in women who have scar tissue from previous surgeries. The most common complications are urinary tract infection, and erosion of the vaginal wall near the tape.

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