title: In situ vaginal wall sling.
abstract: BACKGROUND
  Recent reviews have noted failures of transvaginal surgical procedures designed to cure female stress urinary incontinence (SUI). Slings for SUI appear to sustain continence over time but have been reserved for the more complex cases of intrinsic sphincteric deficiency because of the perception by many surgeons of increased technical difficulty and complication rates. However, this very success in complex cases of SUI bespeaks the need to develop modifications to simplify sling surgery so as to encourage sling use in all women with SUI. Modifications continue to be applied, including anchoring the supporting sutures to the pelvic bones and reducing the transvaginal dissection to prevent further prolapse. I review the use of the in situ anterior vaginal wall sling using bone anchoring techniques with preservation of the endopelvic fascia.
  
  
  METHODS
  The in situ sling is performed with the patient in the dorsal lithotomy position under regional or general anesthesia, with a 16F Foley catheter placed in the bladder and a weighted vaginal speculum on the posterior vaginal wall. An anterior vaginal suburethral patch is supported by nonabsorbable sutures anchored to the pubic bone.
  
  
  CONCLUSIONS
  The use of bone anchoring techniques with preservation of the endopelvic fascia appears to enhance the success rate of autologous vaginal wall slings without increasing the risk to the patient and, as minimally invasive procedures, these techniques appear to reduce surgical time and length of hospitalization, thus reducing costs.
authors.affiliation: Section of Voiding Dysfunction and Female Urology, Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Appell
mesh_terms: D005260:Female; D006801:Humans; D013536:Suture Techniques; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D014621:Vagina / Q000601:surgery*