Healthcare Professionals
Various techniques for performing sling procedures have evolved over the last 30 years. In the past 7 years, new types of synthetic sling materials have gained popularity along with the concept of placing the sling in the area of the mid-urethra. The combination of an improved synthetic mid-urethral sling with introduction of instruments designed to facilitate passage of the sling through the obturator foramen has been a significant advance in the treatment of female stress incontinence.
Many surgical options have been developed for the correction of SUI due to hypermobility and/or ISD. Boston Scientific offers a variety of mid urethral slings which are designed to be used for minimally invasive procedures. The difference being in the rate of administration and placement of the “anchoring” location of the mesh material.
There are 3 sling placement options:
1: Pre-pubic Sling Placement
The Prefyx PPS™ System is designed to provide safe and effective treatment of urinary incontinence and sphincter deficiency. The sling is placed outside the pelvic bowl potentially reducing the incidence of organ and vascular injury.*
2: Transobturator Sling Placement
The Obtryx® Transobturator Mid-Urethral Sling System is designed to offer the surgeon a distinctive and versatile transobturator approach for treating stress urinary incontinence.
The surgeon has a choice of two different needle configurations, the curved needle or the halo needle.
3: Retropubic Sling Placement
The Lynx® Suprapubic Mid-Urethral Sling System is designed to offer the surgeon a system for treating incontinence that is disctinctive and maneuverable.
The Advantage® Transvaginal Mid-Urethral Sling System includes an innovative mid-urethral sling that offers several advancements in delivery and tensioning, all of which are designed to meet the demands of the physician.
All of these systems use our Advantage® Mesh - The Advantage Mesh is designed to reduce the risks of mesh deformation during tensioning and irritation to the anterior vaginal wall.
The sling procedure is performed under either a general or spinal anesthetic. The choice of anesthesia type is made based upon patient preference and clinical factors considered by the anesthesiologist.
A small incision is made in the vaginal area and two small incisions are made through the skin in the groin area. Next, the synthetic mesh is placed. When it is placed, it will extend from one skin incision, in towards the vagina, around the urethra and back out though the second skin incision. This creates a “U-Shaped hammock” of support around the urethra. The sling system is designed to add support to the urethra and stabilize it as well. With the sling in place, normal urinary function may be restored.
The mesh tension is adjusted so that the leakage of urine is reduced. After the positioning of the mesh, the small incisions in the groin area and the top of the vaginal canal will be closed and bandaged.
After the procedure:
The post-void residual urine volume is checked after surgery. When the patient is unable to void or if the post void residual volume is > 100cc, the patient is reinstructed in the technique of self-catheterization that she learned before the sling procedure.
The patient may be given a prescription for an antibiotic.
The patient may be given a prescription for pain medication. If not, the physician or nurse may recommend an over-the-counter drug.
The patient will be instructed on how to care for the incision area.
Routine physical activity may be restricted for a short time after the procedure. Strenuous activity may be restricted for 6-12 weeks.
See Prescriptive Information regarding specific Boston Scientific product indications, contraindications, precautions and warnings. Please refer to Directions for Use for more complete information.
* Preliminary Procedural and Safety Data from the United States Clinical Study on the AMS Monarc® Subfascial Hammock,as presented at the International Continent Society meeting August 25, 2004 Moore R1, Miklos J1, Knoll L D2, Dupont M3, Winkler H A4, Lind L4, Kohli N5, Serels S6, Karram M7, Walters M8, Davila W9. 1. Northside Hospital, 2. Center for Urological Treatment, 3. Dupont Center for Urology/Urogynecology, 4. North Shore University Hospital, 5. Brigham & Women's Hospital, 6. Urology Associates of Norwalk, 7. Good Samaritan Hospital, 8.Cleveland Clinic, 9. Cleveland Clinic Florida B. Kuuva, N. and Nilsson, C.G. A Nationwide analysis of complications associated with tension free vaginal tape (TVT) procedure. ACTA OBSTET GYNECOL STAND 2002; 81: 72-77 C. Meschia M. et al. Tension free vaginal tape: analysis of outcomes and complications in 404 stress incontinent women (Int. Urogynecol. J. [2001] Supplement to Suppl 2: S24-S27) D. MAUDE -
http://www.fda.gov/cdrh/maude.html E. Data on File Boston Scientific Corporation * Results from an interim analysis and may not represent the trial study outcomes
TVT is a trademark of Ethicon, Inc.
Monarc is a registered trademark of AMS Research Corporation.
