Urethral sling

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Technique for modified urethral sling procedure

Urethral sling formation is a surgical intervention technique for treatment of canine urinary incontinence.

Urethral sling procedures using seromuscular flaps created from the bladder wall or a synthetic material passed transpelvically through the obturator foramen have been combined with colposuspension to provide additional external compression of the pelvic urethra, increasing resistance to urine flow[1]. These procedures are technically more difficult to perform. The reported outcomes are similar to those of colposuspension alone. It remains unclear whether there is an advantage to the use of a combined procedure. The modified sling urethroplasty procedure creates external compression at the vesicourethral junction by wrapping two seromuscular flaps created from the bladder neck region around the proximal urethra to increase resistance to urine flow[2].

Perform a colposuspension as previously described. Following colposuspension, make a 2- to 2.5-cm ventral midline incision through the seromuscular layer of the bladder neck, extending to the junction of the proximal urethra. Raise two rectangular seromuscular pedicle flaps with a caudal base from the ventral surface of the bladder neck region. These flaps should be between 4 and 10 mm in width, depending on the size of the patient. Place a 4-0 absorbable monofilament stay suture through the free end of each flap. Pass the flaps around each side of the proximal urethra and secure them on the dorsal aspect to provide compression at the vesicourethral junction. Primarily close the remaining seromuscular defect on the ventral bladder neck with a simple continuous or interrupted pattern using 4-0 absorbable monofilament sutures. Remove the urethral catheter to permit complete closure of this defect. If necessary, additional sutures can be placed dorsally in the sutured flaps to adjust the tension of the sling. Compression provided by the sling should be such that gentle digital pressure on the bladder is necessary to exceed the urethral pressure that permits urine flow.19 Close the abdomen in a routine manner.

References

  1. Muir P, Goldsmid SE, Bellenger CR. (1994) Management of urinary incontinence in five bitches with incompetence of the urethral sphincter mechanism by colposuspension and a modified sling urethroplasty. Vet Rec 34:38-41
  2. Nickel RF, Wiegand U, Van Den Brom WE. (1998) Evaluation of a transpelvic sling procedure with and without colposuspension for treatment of female dogs with refractory urethral sphincter mechanism incompetence. Vet Surg 27:94-104