title: Sling operations in the treatment of stress urinary incontinence: how to adjust sling tension.
abstract: OBJECTIVE
  To find an objective method of adjusting sling tension in order to avoid postoperative urinary obstruction.
  
  
  METHODS
  Thirty-five female patients with type II/III and type III stress urinary incontinence were treated using a sling procedure. Pubovaginal fascial slings were implanted in 20 patients and polytetrafluoroethylene patch slings with nylon sutures were implanted in 15 patients. During the procedures the urinary bladder was partially full and the patients, who were under spinal or epidural anesthesia, were asked to cough and strain. The proper tension that effectively prevents urine leakage was selected and the corresponding suture length was marked. An objective new method to adjust sling tension was used. As part of this method, the abdominal bulge index is added to the suture length before tying.
  
  
  RESULTS
  Short-term follow-up of 6-12 months showed that 33 of 35 patients reported no leakage of urine (94%). Two patients had unsatisfactory urge incontinence. We did not encounter postoperative urinary retention in any patient. No significant post-voiding residual urine was reported. None of our patients in this series have complained of difficulties during micturition or the need to strain during voiding.
  
  
  CONCLUSIONS
  Proper adjustment of sling tension using the abdominal bulge index has eliminated postoperative urinary retention and obstructed urine flow, including any appreciable amount of post-voiding residual urine. This method has been found to be both objective and reproducible.
authors.affiliation: Department of Urosurgery, Ain Shams University, Cairo, Egypt. mezza80@hotmail.com
authors.forename: Ibraheem Mahmoud
authors.initials: IM
authors.lastname: Ezzat
mesh_terms: D000273:Adipose Tissue; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011126:Polypropylenes / Q000627:therapeutic use; D011312:Pressure; D019736:Prostheses and Implants; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*
chemical_list: D011126:Polypropylenes