41: Sling plication for persistent stress urinary incontinence after midurethral sling

Abstract

To demonstrate the sling plication technique, a treatment option for failed midurethral sling. Persistent or recurrent stress urinary incontinence after midurethral sling placement is a relatively common problem. Treatment options include placement of a second midurethral sling, autologous fascia sling, colposuspension, or urethral bulking. Sling plication is an alternative option that offers some advantages over a repeat sling procedure: it can decrease cost and operative time, and it avoids the risk of trocar injury and additional mesh burden. In this video, we demonstrate the sling plication technique on a 74-year-old patient with persistent stress urinary incontinence 5 weeks after retropubic midurethral sling placement. The key steps are as follows: suburethral incision and sharp dissection to identify the sling; mobilization of 4 cm of the sling; plication with two interrupted, horizontal sutures placed 1cm laterally on each side; application of upward pressure while tying the sutures and tensioning the sling; and closure of the vaginal epithelium. Sling plication is an effective, low-risk option to treat persistent stress urinary incontinence after failed midurethral sling procedures.