Vaginal Slings

Vaginal slings have been described in surgical literature since the early 1900’s.

Early sling procedures required use of large sections of either abdominal or inner thigh muscles to create a sling or hammock under the urethra.  These procedures were only rarely performed until late 1970 when both Dr. Jerry Blaivas and Dr. Edward McGuire reported successful use of rectus muscle fascial slings in patients with the most severe forms of incontinence.  The use of fascia, the strength tissue that overlies muscles, decreased the morbidity of the operation.  Further modification and use of slings proved that they could be used in both complex and simple cases of stress incontinence.  In the mid 1990’s, several novel techniques for performing sling procedures were introduced to surgeons.  Each proved to have excellent success rates with the additional benefit of shorter operative times and less recuperation required by the patient.  In 1998, the tension-free vaginal taping (TVT) procedure was introduced from Sweden.

Dr. Olf Ohlmsted had determined that a sling placed at the mid-urethra was equally as effective as previously performed slings placed at the level of the proximal urethra and bladder neck.  An additional advance was use of a commonly used surgical material woven into a mesh as the sling material.  This provided infinite durability and lack of need for tissue from the patient.  Though this procedure required little operative time (10-15 minutes) and allowed patients to be sent home on the day of surgery, there was the potential for damage to the bladder and intra-abdominal structures with passage of the mesh inserters.  Fortunately, over 500,000 TVT procedures have been performed with very small numbers of complications.