Mayo surgeons performing new sling procedure to treat stress urinary incontinence

Surgeons at Mayo Clinic are performing a new procedure to treat women with stress urinary incontinence. The procedure involves implanting a small, adjustable sling, which acts like a hammock, to support the bladder neck and control leakage.

The procedure is the latest in minimally invasive incontinence procedures performed by Mayo Clinic urogynaecologists. It offers the potential for better results for two reasons. Optimal leakage control is possible because the sling tension is adjusted after the procedure while the patient exerts the type of abdominal pressure that causes her to leak, and the sling tension can be readjusted months, or years, later without undergoing additional surgery. Dr. Paul Pettit, a Mayo Clinic urogynaecologist 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 or loosen the sling tension,” he 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,” he says. 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 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 since pregnancy and childbirth tend to weaken the pelvic floor muscles. An estimated 10 to 30 percent of women between 15 and 64 have urinary incontinence. Pettit says the adjustable sling procedure may be the best option for women who’ve had other surgical procedures to treat incontinence without satisfactory results and for those with indications that setting optimal sling tension during surgery may be difficult. The procedure takes about 30 minutes to perform and can be done under regional or local anaesthesia. It may be performed as an outpatient procedure or with an overnight stay in the hospital. The surgeon makes a small vaginal incision to insert the sling and position it to support the neck of the bladder. The sling consists of two synthetic threads and a tiny piece of synthetic mesh. The surgeon makes another small incision in the lower abdomen to draw the threads up into the tensioning device. The tensioning device, which is a little bigger than a grape, 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 removed, and the opening closed. The patient can have the tension readjusted, if necessary, months to years later in the outpatient surgery setting or in the surgeon’s office. Urine leakage is caused by nerve and muscle damage. “We are not able to reverse nerve and muscle damage,” Pettit says. “Slings allow us to compensate for the nerve and muscle injury, but a patient may need other forms of therapy for their loss of urine in addition to the sling because of the nerve and muscle damage.” (Source: Mayo Clinic in Jacksonville: July 2006).