Persistent or recurrent stress urinary incontinence after midurethral sling placement is not uncommon. Treatment options include placement of a second midurethral sling, autologous fascial sling, retropubic urethropexy, or urethral bulking. Shortening of the sling by plication has also been suggested as an alternative option which may reduce operative time, cost, risk of trocar injury, and mesh burden. In this video, we aimed to demonstrate our technique and experience on sling plication.
The key steps of the procedure are as follows: (1) suburethral incision and sharp dissection to identify the sling; (2) mobilization of the suburethral portion of the sling; (3) plication with two interrupted, horizontal sutures placed 1 cm laterally on each side; (4) application of upward pressure while tying the sutures and tensioning the sling. In our experience, we have found this technique to be most successful for retropubic slings, especially when performed within 2-12 weeks of the initial surgery.
Sling plication is an effective and minimally invasive option to treat persistent stress urinary incontinence after failed midurethral sling procedures. It avoids additional mesh burden or more invasive retropubic surgery and should be offered as a treatment option for appropriately counseled patients.
International urogynecology journal. 2022 Oct 15 [Epub ahead of print]
Christina H Swallow, Leslie M Rickey, Oz Harmanli
Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, 310 Cedar St, FMB 329, New Haven, CT, 06519, USA. ., Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, 310 Cedar St, FMB 329, New Haven, CT, 06519, USA.