The pubovaginal sling: Reintroducing an old friend

Abstract

The surgical management of female stress urinary incontinence (SUI) has evolved over the past century, using various techniques of retropubic colposuspensions and sling procedures. In the past two decades, the sling has become the mainstay of surgical treatment of SUI, with the synthetic midurethral sling (MUS) leading the way. With the recent concerns raised by the U.S. Food and Drug Administration (FDA) and Health Canada about the safety of vaginal surgery using mesh implants, including the MUS, urologists and gynecologists should be familiar with suitable alternatives, including the pubovaginal sling (PVS), which often incorporates autologous fascia. Surgeons should be expected to discuss the surgical options to patients in more detail so that an informed decision can be made by both parties on which surgery to choose. Despite the MUS still being considered the “gold standard” by many, both the urologist and gynecologist who manage SUI should understand the indications for a PVS with autologous fascia, as well as its surgical technique and outcomes. This knowledge is required to aid in the decision-making of both the patient and her surgeon. In this article, the role of the PVS and the description of its surgical technique are presented.