44 year old Woman with Stress Urinary Leakage Mini Sling

MF is a 44 year old woman who presented with urinary leakage with laugh, cough sneeze and with exercise, classic symptoms of stress urinary incontinence (SUI). She previously delivered2 children vaginally with no complications, current ages 10 and 14. She developed occasional urinary leakage with big sneezes or coughing in her 30’s, but it was rare and did not really affect her quality of life. Over the past few years, however, she developed worsening urinary leakage with physical events. She had lost weight and had been exercising more, however the urinary leakage was having an impact on her quality of her life as her leakage was worsening, she was having to wear pads when exercising, and found that she was avoiding certain exercises secondary to the leakage. She used to play tennis when younger, but when she tried to take the sport back up, her leakage was preventing her from being able to enjoy the game. She would try to empty her bladder prior to these activities, but even this didn’t seem to make a difference. Ultimately, she also began leaking urine with intercourse and because of this it was impacting her sex life and her marriage.

She tried physical therapy and pelvic floor muscle exercises, however saw no improvement of her condition. She wanted a minimally invasive approach and wanted to avoid surgery, so she tried Thermi Va ,an office base vaginal radio-frequency therapy which has been show to help with mild SUI (similar success rates to laser therapy such as Mona Lisa or Femi-Lift), however this did not help her symptoms improve. We reviewed her surgical options and since she had no associated prolapse (and ie pelvic organ prolapse such as her bladder dropping, also called cystocele) and did not want abdominal surgery she opted for a single-incision sling or a mini-sling.

The mini, or single-incision sling is a procedure that can be completed as an outpatient procedure in as little as 10-15 minutes under local anesthesia and some mild sedation. It was developed in 2008 as an alternative to the full-length slings such as the retropubic TVT type sling which goes through the abdominal wall or the transobturator sling (TOT) which goes all the way through exit points in the groins. The TOT sling can be as long as 15 cm in length and risks pain in the groins and legs and therefore the mini-sling was developed to reproduce the natural position of the TOT sling, but reduce the mesh load, not have mesh exiting in the groins/legs and eliminate the risk of groin or leg pain. The mesh is only 5cm long and replaces the damaged pubo-urethral ligament, which prevents leakage with physical events such as laugh, cough, sneeze, jumping, exercise etc. Over the years, the cure rates of the mini-sling have been shown to have equivalent cure rates to the full-length mesh tape slings, with reduced risks and only 1 incision instead of 3. We at Miklos and Moore Urogynecology helped develop this technology and published some of the first studies in the literature on the technique and have been using it for over 10 years. Cure rates are in the range of 90%.

MF had the procedure completed without complications, went home the same day as the procedure, recovered within a few days , back to work by 1 week and was back playing tennis and exercising with no leakage by 6 weeks. She is 100% satisfied with her results

Mid-Urethral Mesh tape slings (MUS), which the mini-sling is part of this family, are considered gold standard treatment for female SUI. The FDA as well as the American Urologic Association and the American Urogynecology Association endorse the procedure as a gold-standard treatment of female SUI (link here for position statement from AUGS on mid urethral slings).

No exit points needed
Smallest mesh procedure for SUI
5CM Mesh

3 incisions Mesh exits groins on both sides Mesh in groins risk leg pain 14cm Mesh

TVT (RP) Sling
Full Length
3 incisions
Mesh exits through abdominal wall
18cm mesh