Vaginal sling surgery: Overview, history, and sling material

The pubovaginal sling (PVS) is considered the gold standard for the treatment of female stress urinary incontinence (SUI). Originally described for the treatment of intrinsic sphincter deficiency (ISD), PVSs have been utilized to treat other types of SUI. There have been many modifications to the technique over the years, but the principles behind the PVS still hold today. The sling is placed beneath the proximal urethra and bladder neck to provide support and compression and to prevent proximal urethral descent during increased intra-abdominal pressure. Numerous materials have been utilized over the years to construct slings, and newer materials continue to be introduced in an attempt to decrease morbidity and improve durability of the procedure and patient satisfaction. This chapter will discuss the history of the PVS and examine the various materials used to construct slings as well as the different fixation techniques available.