ABSTRACT
The sling procedure for the treatment of urinary incontinence in women was described by
Goebell in 1910 using gracilis muscle (1) and was later modified by Aldrigde in 1942 (2), who
first described using abdominus rectus fascia for urethral compression. Since its inception in the
early part of the 20th century, the sling procedure had been modified and ultimately replaced by
other forms of anti-incontinence surgery, such as the retropubic and transvaginal bladder neck
suspensions. The concept of using a fascial strip to provide compression of the urethra was
revitalized in 1978, when McGuire et al. (3) described its use in the treatment of type III stress
urinary incontinence (SUI), or incontinence secondary to intrinsic sphincter deficiency (ISD).
Until very recently, the sling procedure was thought to only be effective in the treatment of ISD,
and anatomic descent was best treated with bladder neck suspension procedures. However, it is
now widely accepted as an effective treatment for type II SUI, or incontinence resulting from
urethral hypermobility/anatomic descent. The sling procedure has now gained widespread use by both urologists and gynecologists. Cure rates for both types II and III incontinence range from
75% to 93%, with 95-98% of women reporting significant improvement in symptoms (4,5).
However, along with its success and expanded utility has come a greater knowledge of the
complication profile. We are now aware of several well-described complications of the sling
procedure: urethral obstruction, de novo urgency, urethral/vaginal erosion, and infection. This chapter will review the diagnosis and management of the most commonly described
complications of the sling procedure.
