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The Bladder Neck Sling: What Role Remains?

  • Female Stress Incontinence and Prolapse (R Dmochowski, Section Editor)
  • Published:
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Abstract

A decade ago, bladder neck slings were recognized as the gold standard technique for a majority of patients. Today, tension-free vaginal tape is widely accepted as the standard approach for index surgery in female stress urinary incontinence. Recently published articles have demonstrated a decrease in the use of bladder neck slings and a significant increase in the use of mid urethral synthetic slings. Currently, bladder neck sling procedures appear to confer a cure rate similar to open retropubic colposuspension and mid urethral sling procedures, but the long-term adverse event profiles are still unclear. Although, bladder neck slings remain in the armamentarium of pelvic surgeons, they are reserved mainly for pediatric patients and for complex patients at high risk for urethral damage, with recurrent urinary incontinence and with low-pressure urethras, as well as for the patients who may refuse having synthetic slings. This article reviews the role of bladder neck slings in the era of the midurethral slings.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Blaivas J, Chaikin D. Pubovaginal fascial sling for the treatment of all types of stress urinary incontinence: surgical technique and long-term outcome. Urol Clin NA. 2001;38:7–15. doi:10.1016/j.ucl.2010.12.002.

    Article  Google Scholar 

  2. Goebel R. Zur operativen besteitigung der anger- borenen incontinenz vesicae. Zeitscher Gynakol. 1910;2:187–91.

    Google Scholar 

  3. Aldridge AH. Transplantation of fascia for relief of urinary stress incontinence. Am J Obst Gynecol. 1942;44:398.

    Google Scholar 

  4. Low JA. Management of severe anatomic deficiencies of urethral sphincteric function by a combined procedure with a fascia lata sling. Am J Obst Gynecol. 1969;105:149.

    CAS  Google Scholar 

  5. Sloan WR, Banvin BN. Stress incontinence of urine: a retrospective study of the complications and late results of simple suprapubic suburethral fascial slings. J Urol. 1973;110:533.

    PubMed  CAS  Google Scholar 

  6. Blaivas JG, Jacobs BZ. Pubovaginal fascial sling for the treatment of complicated stress urinary incontinence. J Urol. 1991;145:1214.

    PubMed  CAS  Google Scholar 

  7. Hohenfellner R, Petri E. Sling procedures. In: Stanton SL, Tanagho EA, editors. Surgery of female incontinence. New York: Springer; 1980. p. 69–76.

    Google Scholar 

  8. Woodside JR, Borden TA. Pubovaginal sling procedure for the management of urinary incontinence in a myelodysplastic girl. J Urol. 1982;127:744.

    PubMed  CAS  Google Scholar 

  9. McGuire EJ, Wang C-C, Usitalo H, Savastano J. Modified pubovaginal sling in girls with myelodysplasia. J Urol. 1986;135:94.

    PubMed  CAS  Google Scholar 

  10. Raz S, McGuire EJ, Ehrlich RM, Zeidman EJ, Wang SC, Alarcon A, Schmidtbauer C, McLaughlin S. Fascia1 sling to correct male neurogenic sphincter incompetence: the McGuireRaz approach. J Urol. 1988;139:528.

    PubMed  CAS  Google Scholar 

  11. Herschorn S, Radomski SB. Fascia1 slings and bladder neck tapering in the treatment of male neurogenic incontinence. J Urol. 1992;147:1073.

    PubMed  CAS  Google Scholar 

  12. •• Rehman H, Bezerra CC, Bruschini H, Cody JD. Traditional suburethral sling operations for urinary incontinence in women. Cochrane Database Syst Rev. 2011;(1):CD001754. An updated Cochrane review which is dedicated to the traditional slings, including bladder neck slings. The study gives a comprehensive knowledge about efficacy and complications of pubovaginal slings.

  13. Zimmern P, Urinary Incontinence Treatment Network (UITN). Design of the SISTEr (Stress Incontinence Surgical Treatment Efficacy Trial) Study: A randomized surgical trial comparing Burch colposuspension and the autologous rectus fascia sling. A clinical trial of the NIH/NIDDK urinary incontinence treatment network (UITN) (Abstract number 81). Progres en Urologie. 2004;14(3 Suppl 3):26. [:19780]

    Google Scholar 

  14. Albo ME, Richter HE, Brubaker L, Norton P, Kraus SR, Zimmern PE, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med. 2007;356(21):2143–55. see comment.

    Article  PubMed  CAS  Google Scholar 

  15. Albo M, Wruck L, Baker J, Brubaker L, Chai T, Dandreo KJ, et al. The relationships among measures of incontinence severity in women undergoing surgery for stress urinary incontinence. J Urol. 2007;177(5):1810–4.

    Article  PubMed  Google Scholar 

  16. • Chai TC, Albo ME, Richter HE, Norton PA, Dandreo KJ, Kenton K, et al. Complications in women undergoing Burch colposuspension versus autologous rectus fascial sling for stress urinary incontinence. J Urol. 2009;181(5):2192–7. [: 31150]. The paper is dedicated to analysis of all adverse events noticed in the SISTEr study where the patients with stress urinary incontinence were randomized to Burch procedure or fascial bladder neck slings.

  17. • Brubaker L, Richter HE, Norton PA, et al. 5-Year continence rates, satisfaction and adverse events of Burch urethropexy and fascial sling surgery for urinary incontinence. J Urol. 2012;187:1324. Extended follow-up of the SISTEr study participants (E-SISTEr) provides an important view into the long-term results for women who have undergone bladder neck surgery for SUI.

    Article  PubMed  CAS  Google Scholar 

  18. Richter HE, Brubaker L, Stoddard AM, Xu Y, Zyczynski HM, Norton P, Sirls LT, Kraus SR, Chai TC, Zimmern P, Gormley EA, Kusek JW, Albo ME. Patient related factors associated with long-term urinary continence after burch colposuspension and pubovaginal fascial sling surgeries. J Urol. 2012;188(2):485–9.

    Article  PubMed  Google Scholar 

  19. Sand PK, Bowen LW, Panganiban R, Ostergard DR. The low pressure urethra as a factor in failed retropubic urethropexy. Obstet Gynecol. 1987;69:399–402.

    PubMed  CAS  Google Scholar 

  20. Maher CF, O'Reilly BA, Dwyer PL, Carey MP, Cornish A, Schluter P. Pubovaginal sling versus transurethral Macroplastique for stress urinary incontinence and intrinsic sphincter deficiency: a prospective randomised controlled trial. BJOG: Int J Obstet Gynecol. 2005;112(6):797–801.

    Article  Google Scholar 

  21. Sand PK, Winkler H, Blackhurst DW, Culligan PJ. A prospective randomized study comparing modified Burch retropubic urethropexy and suburethral sling for treatment of genuine stress incontinence with low-pressure urethra. Am J Obstet Gynecol. 2000;182(1 Pt 1):30–4.

    Article  PubMed  CAS  Google Scholar 

  22. Horbach NS, Blanco JS, Ostergard DR, Bent AE, Cornella JL. A polytetrafluoroethylene suburethral sling procedure for the treatment of genuine stress incontinence in patients with low urethral closure pressure. Obstet Gynecol. 1988;71:648–52.

    PubMed  CAS  Google Scholar 

  23. Wadie B, Henawy A. Does urethral pressure measurement correlate to the outcome of incontinence surgery? (Abstract number 546). Proceedings of the 37th Annual Meeting of the ICS, 20-24 Aug 2007, Rotterdam, The Netherlands. 2007.

  24. Wadie BS, El Hefnawy AS. Urethral pressure measurement in stress incontinence: does it help? Int Urol Nephrol. 2009;41(3):491–5.

    Article  PubMed  Google Scholar 

  25. Wang SC, McGuire EJ, Bloom DA. A bladder pressure management system for myelodysplasia-clinical outcome. J Urol. 1988;140:1499.

    PubMed  CAS  Google Scholar 

  26. McGuire EJ, Wang CC, Usitalo H, et al. Modified pubovaginal sling in girls with myelodysplasia. J Urol. 1986;135:94.

    PubMed  CAS  Google Scholar 

  27. Austin P, Westney L, Leng W, Mc GE, Ritchey M. Advances of rectus fascial slings for urinary incontinence in children with neuropathic bladders. J Urol. 2001;165:2369–72.

    Article  PubMed  CAS  Google Scholar 

  28. Perez LM, Smith EA, Broecker BH, et al. Outcome of sling cystourethropexy in the pediatric population: a critical review. J Urol. 1996;156:642.

    Article  PubMed  CAS  Google Scholar 

  29. Nguyen H, Bauer S, Diamond D, Retik A. Rectus fascial sling fort he treatment of neurogenic sphincteric incontinence in boys: is it safe and effective? J Urol. 2011;166:658–61.

    Article  Google Scholar 

  30. Brubaker L, Stoddard A, Richter H, Zimmern P, Moalli P, Kraus SR, et al. Mixed incontinence: comparing definitions in women having stress incontinence surgery. Neurourol Urodyn. 2009;28(4):268–73.

    Article  PubMed  Google Scholar 

  31. Osman T. Stress incontinence surgery for patients presenting with mixed incontinence and a normal cystometrogram. BJU Int. 2003;92:964–8.

    Article  PubMed  CAS  Google Scholar 

  32. Guerrero K, Whareham K, Watkins A, Ismail S, Lucas M, Emery S. A randomised control trial comparing TVT, pelvicol and autologous fascial slings for the management of stress urinary incontinence in women (Abstract number 1). Neurourol Urodyn. 2008;27(7):571.

    Google Scholar 

  33. Lucas M, Emery S, Alan W, Kathy W. Failure of porcine xenograft sling in a randomised controlled trial of three sling materials in surgery for stress incontinence (Abstract). Proceedings of the International Continence Society (34th Annual Meeting) and the International UroGynecological Association, 23-27 August, 2004, Paris. 2004:Abstract number 309.

  34. Amaro JL, Yamamoto HA, Kawano PR, Fugita O, Gameiro MOO, Barros G, et al. A prospective randomized trial of autologous fascial sling (AFS) versus tension-free vaginal tape (TVT) for treatment of stress urinary incontinence (SUI) (Poster abstract number 1460). J Urol. 2007;177(4 Suppl 4):482.

    Google Scholar 

  35. Sharifiaghdas F, Mortazavi N. Tension-Free vaginal tape and autologous rectus fascia pubovaginal sling for the treatment of urinary stress incontinence: a medium term follow-up. Med Princ Pract. 2008;17:209–14.

    Article  PubMed  Google Scholar 

  36. Jeon MJ, Jung HJ, Chung SM, et al. Comparison of the treatment outcome of pubovaginal sling, tension-free vaginal tape, and transobturator tape for stress urinary incontinence with intrinsic sphincter deficiency. Am J Obstet Gynecol. 2008;199:76.e1–e4.

    Article  Google Scholar 

  37. Flisser AJ, Blaivas JG. Outcome of urethral reconstructive surgery in a series of 74 women. J Urol. 2003;169:2246–9.

    Article  PubMed  Google Scholar 

  38. Petrou SP, Frank I. Complications and initial continence rates after a repeat pubovaginal sling procedure for recurrent stress urinary incontinence. J Urol. 2001;165:1979–81.

    Article  PubMed  CAS  Google Scholar 

  39. Migliari R, Pistolesi D, D'Urso L, et al. Recurrent pseudodiverticula of female urethra: five-year experience. Urology. 2009;73:1218–22.

    Article  PubMed  Google Scholar 

  40. Welk BK, Herschorn S. The autologous fascia pubovaginal sling for complicated female stress incontinence. Can Urol Assoc J. 2012;6(1):36–40.

    PubMed  Google Scholar 

  41. Pushkar DY, Dyakov VV, Kosko JW, Kasyan GR. Management of urethrovaginal fistulas. Eur Urol. 2006;20:873–1128.

    Google Scholar 

  42. Oliphant SS, Wang L, Bunker CH, et al. Trends in stress urinary incontinence inpatient procedures in the United States, 1979-2004. Am J Obstet Gynecol. 2009;200:521.e1–e6.

    Article  Google Scholar 

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  1. Urology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia

    Dmitry Pushkar & George Kasyan

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  1. Dmitry Pushkar
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  2. George Kasyan
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Correspondence to George Kasyan.

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Pushkar, D., Kasyan, G. The Bladder Neck Sling: What Role Remains?. Curr Bladder Dysfunct Rep 8, 32–37 (2013). https://doi.org/10.1007/s11884-012-0166-3

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