UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

PUBOVAGINAL SLING OPERATIONS

Çağdaş Çöllüoğlu

Başkent University İzmir Hospital, Department of Gynecology and Obstetrics, İzmir, Türkiye

Çöllüoğlu Ç. Pubovaginal Sling Operations. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.181-190.

ABSTRACT

Stress urinary incontinence (SUI) is a common urogynecological disorder characterized by involuntary leakage of urine during coughing, exertion, or physical activity. The lifetime prevalence in women reaches up to 40%, and it may increase to 65% in the 45-49 age group. Urinary incontinence represents not only a hygienic problem but also a significant social and psychological burden. Feelings of embarrassment often prevent women from seeking medical care, and thus the condition substantially impairs quality of life.

Although various conservative and medical treatment options exist, surgical management remains the most definitive and satisfactory approach, particularly in moderate-to-severe cases of SUI. The main principle of surgery is to restore functional support to the urethra and bladder neck, thereby preventing leakage during episodes of increased intra-abdominal pressure. In this context, pubovaginal sling procedures have been proven effective for both intrinsic sphincter deficiency and urethral hypermobility. Pubovaginal sling is especially preferred in complex or recurrent cases, with high success rates depending on patient selection, surgical technique, associated pelvic floor defects, and history of prior interventions.

Potential complications include urinary retention, bladder perforation, exacerbation of lower urinary tract symptoms, and, less commonly, infection or graft erosion. Therefore, thorough preoperative counseling is an essential part of surgical planning. Several sling materials can be used, including autologous, allograft, and synthetic options. Synthetic grafts offer advantages such as shorter operative time and reduced hospitalization; however, they are associated with significant complications including foreign body reactions and erosion. Due to the increased recognition of these adverse events and subsequent regulatory restrictions, autologous graft-based pubovaginal sling procedures have regained popularity in recent years. The rectus fascia is the most commonly used autologous material, while fascia lata is employed less frequently.

Given their high long-term success rates and acceptable complication profiles, autologous pubovaginal slings are considered the first-line surgical option in patients with recurrent incontinence after failed procedures and particularly in those with predominant intrinsic sphincter deficiency. In the future, advances in biomaterial technologies and the refinement of minimally invasive surgical techniques are expected to further enhance the safety, patient comfort, and long-term outcomes of pubovaginal sling surgery.

Keywords: Urinary incontinence, stress; Suburethral slings; Tissue and organ harvesting

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