Type of Surgery
Last updated: 02/17/2009
Regardless of the procedure used, a proportion of patients will remain incontinent. Results vary according to the type of sling procedure used, the type of attachment used for the sling, and the type of material used for the sling. Normal results for...
the sling procedure overall are recurrent stress incontinence of 3â€“12% after bladder sling procedures. In general, reported cure rates are lower for second and subsequent surgical procedures. A recent qualitative study published in the American Journal of Obstetrics and Gynecology of 57 patients who underwent patient-contributed fascial sling procedures indicates good success with fascial sling procedures. At a median of 42 months after the procedure, the postoperative objective cure rate for stress urinary incontinence was 97%, with 88% of patients indicating that the sling had improved the quality of their lives. Eighty-four percent of patients indicated that the sling relieved their incontinence long term, and 82% of patients stated that they would undergo the surgery again. The study also found that voiding function was a common side effect in 41% of the patients.
The sling procedure, or suburethral sling procedure, refers to a particular kind of surgery using ancillary material to aid in closure of the urethral sphincter function of the bladder. It is performed as a treatment of severe urinary incontinence. The sling procedure, also known as the suburethral fascial sling or the pubovaginal sling, has many forms due to advances in the types of material used for the sling. Some popular types of sling material are Teflon (polytetrafluoroethylene), Gore-TexÂ®, and rectus fascia (fibrous tissue of the rectum). The surgery can be done through the vagina or the abdomen and some clinicians perform the procedure using a laparoscopeâ€”a small instrument that allows surgery through very small incisions in the belly button and above the pubic hairline. The long-term efficacy and durability of the laparoscopic suburethral sling procedure for management of stress incontinence are undetermined. A new technique, the Tension-Free Vaginal Tape Sling Procedure (TVT), has gained popularity in recent years and early research indicates high success rates and few postoperative complications. This procedure is done under local anesthetic and offers new opportunities for treatment of stress incontinence. However, TVT has not been researched for its long-term effects. Finally, there are many surgeons who use the sling procedure for all forms of incontinence.
It's a controversial arena -- the PSA is a marker of prostate bulk and size, but it's highly expressed in benign prostate disease as well as cancer -- so in that context it's not a specific marker.
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