UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

INTRAVAGINAL SLINGPLASTY (IVS)

Belgin Savran Üçok

Ankara Etlik City Hospital, Department of Gynecology and Obstetrics, Ankara, Türkiye

Savran Üçok B. Intravaginal Slingplasty (IVS). In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.243-250.

ABSTRACT

Pelvic organ prolapse (POP) is a gynecological condition that more commonly affects multiparous and older women and significantly impacts quality of life. In surgical treatment, it is essential to consider not only anatomical reconstruction but also functional outcomes. Although the traditional treatment approach involves vaginal hysterectomy combined with anterior and posterior repair (colporrhaphy), the high recurrence rates associated with these methods have led to the development of new surgical technique. Intravaginal slingplasty (IVS) is a minimally invasive surgical technique developed to restore physiological support, used in the repair of apical, anterior, and posterior vaginal wall prolapses. This technique was first developed and defined in 1997 by Professor Dr. Peter Petros. Petros pioneered an approach called the “integral theory” in the treatment of pelvic organ prolapse and urinary incontinence, and described the techniques of posterior intravaginal slingplasty (PIVS) and anterior IVS for the support of the vaginal apex . Anterior IVS was initially applied in the surgical treatment of stress urinary incontinence, and its effectiveness was later demonstrated in cystocele repair. High anatomical success rates have been reported with the use of polypropylene mesh; however, the occurrence of complications such as mesh erosion and dyspareunia has limited its widespread application. Posterior IVS, on the other hand, is preferred particularly in the treatment of rectocele and apical prolapse, standing out with its short operative time and high success rates. In the literature, posterior IVS has been associated with 75?98% anatomical correction, and long-term follow-up studies have reported success rates exceeding 90%. When choosing between vaginal and laparoscopic approaches, factors such as the type and stage of prolapse, accompanying symptoms, the patient’s lifestyle, and the surgeon’s experience should be taken into account. Although IVS techniques achieve success rates of 80-95%, recurrence is more frequent in advanced stages of prolapse. Moreover, mesh-related complications such as erosion, pain, and fistula formation are important considerations in surgical planning. Therefore, current guidelines emphasize the importance of informed consent in cases where mesh is used and recommend considering alternative native tissue repairs. In conclusion, intravaginal slingplasty represents a minimally invasive, uterus-preserving option in POP surgery, providing high patient satisfaction and constituting an integral part of individualized treatment strategies.

Keywords: Minimally invasive surgical procedures; Pelvic organ prolapse

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