Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Suitability of different sling materials for the treatment of female stress urinary incontinence

Nature Clinical Practice Urology volume 2, pages 84–91 (2005)Cite this article

Abstract

Stress urinary incontinence (SUI) is defined as leakage of urine with a sudden increase in intra-abdominal pressure, such as that seen with laughing, lifting, or changing position, without a concomitant rise in detrusor (bladder-generated) pressure. The proposed mechanism of SUI is that an increase in intra-abdominal pressure resulting from various activities causes the bladder pressure to rise above the urethral pressure. The pubovaginal sling remains the standard treatment for female SUI in the US. The market has been flooded with innumerable sling materials. This review discusses the currently available sling materials, surgical approaches, and clinical outcomes data. Long-term data on efficacy is lacking, but early results with new materials and delivery techniques indicate that excellent cure rates with minimal morbidity and high patient satisfaction may be achievable.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Leach GE et al. (1997) Female Stress Urinary Incontinence Clinical Guidelines Panel summary report on surgical management of female stress urinary incontinence. The American Urological Association. J Urol 158: 875–880

    Article  CAS  Google Scholar 

  2. Bezerra CA et al. (2001) Suburethral sling operations for urinary incontinence in women. Cochrane Database Syst Rev 3: CD001754

    Google Scholar 

  3. Morgan JE et al. (1985) The Marlex sling operation for the treatment of recurrent stress urinary incontinence: a 16-year review. Am J Obstet Gynecol 151: 224–226

    Article  CAS  Google Scholar 

  4. Carr LK et al. (1997) Favorable outcome of pubovaginal slings for geriatric women with stress incontinence. J Urol 157: 125–128

    Article  CAS  Google Scholar 

  5. Wheatcroft SM et al. (1997) Complications of fascia lata harvesting for ptosis surgery. Br J Ophthalmol 81: 581–583

    Article  CAS  Google Scholar 

  6. Naugle TC Jr et al. (1997) High leg incision fascia lata harvesting. Ophthalmology 104: 1480–1488

    Article  Google Scholar 

  7. Mubiayi N et al. (2003) Epithelial inclusion cyst formation after buried vaginal mucosa. Diagnosis and management. Gynecol Obstet Fertil 31: 1013–1017

    Article  CAS  Google Scholar 

  8. Kaplan SA et al. (2000) Prospective analysis of 373 consecutive women with stress urinary incontinence treated with a vaginal wall sling: the Columbia-Cornell University experience. J Urol 164: 1623–1627

    Article  CAS  Google Scholar 

  9. Kaplan SA et al. (1996) Comparison of fascial and vaginal wall slings in the management of intrinsic sphincter deficiency. Urology 47: 885–889

    Article  CAS  Google Scholar 

  10. Simonds RJ et al. (1992) Transmission of human immunodeficiency virus type 1 from a seronegative organ and tissue donor. N Engl J Med 326: 726–732

    Article  CAS  Google Scholar 

  11. Beck RP et al. (1988) The fascia lata sling procedure for treating recurrent genuine stress incontinence of urine. Obstet Gynecol 72: 699–703

    CAS  PubMed  Google Scholar 

  12. Handa VL et al. (1996) Banked human fascia lata for the suburethral sling procedure: a preliminary report. Obstet Gynecol 88: 1045–1049

    Article  CAS  Google Scholar 

  13. Bedrossian EH Jr et al. (1989) HIV and banked fascia lata. Trans Pa Acad Ophthalmol Otolaryngol 41: 831–833

    PubMed  Google Scholar 

  14. Cutz A et al. (1977) Tensile strength of fascia lata sutures following gamma radiation. Can J Ophthalmol 12: 211–215

    CAS  PubMed  Google Scholar 

  15. Lemer ML et al. (1999) Tissue strength analysis of autologous and cadaveric allografts for the pubovaginal sling. Neurourol Urodyn 18: 497–503

    Article  CAS  Google Scholar 

  16. Sutaria PM and Staskin DR (1998) Tensile strength of cadaveric fascia lata allograft is not affected by current methods of tissue preparation [abstract 1194]. J Urol 16: 161

    Google Scholar 

  17. Gallentine ML and Cespedes RD (2002) Review of cadaveric allografts in urology. Urology 59: 318–324

    Article  Google Scholar 

  18. Almeida SHM et al. (2004) Banked cadaveric fascia lata: 3-year follow-up. Transplant Proc 36: 993–994

    Article  CAS  Google Scholar 

  19. O'Reilly KJ and Govier FE (2002) Intermediate term failure of pubovaginal slings using cadaveric fascia lata: a case series. J Urol 167: 1356–1358

    Article  Google Scholar 

  20. Palma P et al. (2002) Favorable results from the porcine small intestinal submucosa in the treatment of stress urinary incontinence. BJU Int 90: 251

    Google Scholar 

  21. Rutner AB et al. (2003) Processed porcine small intestine submucosa as a graft material for pubovaginal slings: durability and results. Urology 62: 805–809

    Article  Google Scholar 

  22. Wiedemann A and Otto M (2004) Small intestinal submucosa for pubourethral sling suspension for the treatment of stress incontinence: first histopathological results in humans. J Urol 172: 215–218

    Article  Google Scholar 

  23. Voytik-Harbin SL et al. (1997) Identification of extractable growth factors from small intestinal submucosa. J Cell Biochem 67: 478–491

    Article  CAS  Google Scholar 

  24. Ho KL et al. (2004) 8-Ply small intestinal submucosa tension-free sling: spectrum of postoperative inflammation. J Urol 171: 268–271

    Article  Google Scholar 

  25. Dora CD et al. (2004) Time dependent variations in biomechanical properites of cadaveric fascia, porcine dermis, porcine small intestine submucosa, polypropylene mesh and autologous fascia in the rabbit model: implications for sling surgery. J Urol 171: 1970–1973

    Article  Google Scholar 

  26. Barbalias GA et al. (1997) Gore-Tex sling urethral suspension in type III female urinary incontinence: clinical results and urodynamic changes. Int Urogynecol J Pelvic Floor Dysfunct 8: 344–350

    Article  CAS  Google Scholar 

  27. Yamada T et al. (1998) The correction of type 2 stress incontinence with a polytetrafluoroethylene patch sling: 5-year mean follow-up. J Urol 160: 746–749

    Article  CAS  Google Scholar 

  28. Kassardjian ZG (2004) Sling procedures for urinary incontinence in women. BJU Int 93: 665–670

    Article  CAS  Google Scholar 

  29. Duckett JR and Constantine G (2000) Complications of silicone sling insertion for stress urinary incontinence. J Urol 163: 1835–1837

    Article  CAS  Google Scholar 

  30. Barbalias G et al. (1997) Use of slings made of indigenous and allogenic material (Goretex) in type III urinary incontinence and comparison between them. Eur Urol 31: 394–400

    Article  CAS  Google Scholar 

  31. Hom D et al. (1998) Pubovaginal sling using polypropylene mesh and Vesica bone anchors. Urology 51: 708–713

    Article  CAS  Google Scholar 

  32. Kobashi KC and Govier FE (2003) Management of vaginal erosion of polypropylene mesh slings. J Urol 169: 2242–2243

    Article  CAS  Google Scholar 

  33. Volkmer BG et al. (2003) Surgical intervention for complications of tension-free vaginal tape procedure. J Urol 169: 570–574

    Article  Google Scholar 

  34. Amundsen CL et al. (2003) Urethral erosion after synthetic and nonsynthetic pubovaginal slings: differences in management and continence outcome. J Urol 170: 134–137

    Article  Google Scholar 

  35. Kobashi KC et al. (1999) Erosion of woven polyester pubovaginal sling. J Urol 162: 2070–2072

    Article  CAS  Google Scholar 

  36. Comiter CV and Colegrove PM (2004) High rate of vaginal extrusion of silicone-coated polyester sling. Urology 63: 1066–1070

    Article  Google Scholar 

  37. Tsivian A et al. (2004) Tension-free vaginal tape procedure for the treatment of female stress urinary incontinence: long-term results. J Urol 172: 998–1000

    Article  Google Scholar 

  38. Shah DK et al. (2003) Broad based tension-free synthetic sling for stress urinary incontinence: 5-year outcome. J Urol 170: 849–851

    Article  CAS  Google Scholar 

  39. Abouassaly R et al. (2004) Complications of tension-free vaginal tape surgery: a multi-institutional review. BJU Int 94: 110–113

    Article  Google Scholar 

  40. Kuuva N and Nilsson CG (2002) A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand 81: 72–77

    Article  Google Scholar 

  41. Tamussino KF et al. (2001) Tension-free vaginal tape operation: results of the Austrian registry. Obstet Gynecol 98: 732–736

    CAS  PubMed  Google Scholar 

  42. Hung MJ et al. (2004) Analysis of two sling procedures using polypropylene mesh for treatment of stress urinary incontinence. Int J Gynecol Obstet 84: 133–141

    Article  CAS  Google Scholar 

  43. Rafii A et al. (2003) Body mass index and outcome of tension-free vaginal tape. Eur Urol 43: 288–292

    Article  Google Scholar 

  44. deLancey JO (1996) Stress urinary incontinence: where are we now, where should we go? Am J Obstet Gynecol 175: 311–319

    Article  CAS  Google Scholar 

  45. Delorme E et al. (2004) Transobturator Tape (Uratape): A new minimally-invasive procedure to treat female urinary incontinence. Eur Urol 45: 203–207

    Article  Google Scholar 

  46. deTayrac R et al. (2004) A prospective randomized trial comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of stress urinary incontinence. Am J Obstet Gynecol 190: 602–608

    Article  Google Scholar 

  47. Amundsen CL et al. (2000) Outcome in 104 pubovaginal slings using freeze-dried allograft fascia lata from a single tissue bank. Urology 56 (Suppl 1): 2–8

    Article  CAS  Google Scholar 

  48. Brown SL and Govier FE (2000) Cadaveric versus autologous fascia lata for the pubovaginal sling: surgical outcome and patient satisfaction. J Urol 164: 1633–1637

    Article  CAS  Google Scholar 

  49. Fitzgerald MP et al. (1999) Failure of allograft suburethral slings. BJU Int 84: 785–788

    Article  CAS  Google Scholar 

  50. Carbone JM et al. (2001) Pubovaginal sling using cadaveric fascia and bone anchors: disappointing early results. J Urol 165: 1605–1611

    Article  CAS  Google Scholar 

  51. Chaikin DC et al. (1998) Pubovaginal fascial sling for all types of stress urinary incontinence: long-term analysis. J Urol 160: 1312–1316

    Article  CAS  Google Scholar 

  52. Kuo HC (2001) The surgical results of the pubovaginal sling procedure using polypropylene mesh for stress urinary incontinence. BJU Int 88: 884–888

    Article  CAS  Google Scholar 

  53. Ulmsten U et al. (1998) A multicenter study of tension-free vaginal tape (TVT) for surgical treatment of stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 9: 210–213

    Article  CAS  Google Scholar 

  54. Wang AC (2000) An assessment of the early surgical outcome and urodynamic effects of the tension-free vaginal tape (TVT). Int Urogynecol J Pelvic Floor Dysfunct 11: 282–284

    Article  CAS  Google Scholar 

  55. Choe JM and Staskin DR (1999) Gore-Tex patch sling: 7 years later. Urology 54: 641–646

    Article  CAS  Google Scholar 

  56. Wagner TH et al. (1996) Quality of life of persons with urinary incontinence: development of a new measure. Urology 47: 67–72

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Codirector of the Continence Center at Virginia Mason Medical Center, Seattle

    Kathleen C Kobashi

  2. Clinical Fellow based at the Continence Center, Virginia Mason Medical Center,

    Kenneth C Hsiao

  3. Section of Urology and Renal Transplantation at the Virginia Mason Medical Center,

    Fred E Govier

  4. University of Washington,

    Fred E Govier

Authors
  1. Kathleen C Kobashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenneth C Hsiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fred E Govier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathleen C Kobashi.

Ethics declarations

Competing interests

Kathleen Kobashi is a consultant investigator for the Mentor Corporation, Santa Barbara,CA, and American Medical Systems, Minnesota, MN.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kobashi, K., Hsiao, K. & Govier, F. Suitability of different sling materials for the treatment of female stress urinary incontinence. Nat Rev Urol 2, 84–91 (2005). https://doi.org/10.1038/ncpuro0094

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpuro0094

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing