Value of Technology Advancing Healthcare Through Innovative Technologies and Devices

Sub-Urethral Sling for Stress Urinary Incontinence
Article Title: 
Dr. Richard Kalbfleisch offers relief to women suffering from the last real medical taboo.



1  Canadian Continence Foundation.  "Incontinence: a Canadian Perspective."  (May 2007)

2  World Health Organization. (2008)

3  National Association for Continence. (2008)

4  Nilsson, CGN et al.  "7 Year Follow-up of the Tension-Free Vaginal Tape (TVT) Procedure" International Urogynecology Journal and Pelvic Floor Dysfunction.  14 (Suppl 1):S35 (2003)

Dr. Richard Kalbfleisch offers relief to women suffering from the last real medical taboo.

Embarrassing.  Socially isolating.  Debilitating.  These are some of the words used by patients suffering from Stress Urinary Incontinence.1  And, there are more of them than you may think.

Described as "the last real taboo" among medical disorders by the World Health Organization,2 Stress Urinary Incontinence (SUI) is the sudden, unintentional release of urine during normal, everyday activities such as coughing, laughing or exercising.  Some estimates suggest that up to 10 per cent of the population1, more than 3 million Canadians, can expect to experience SUI in their lifetime.

The condition affects more women, than men,3 and can be a particularly embarrassing complication from childbirth for many women.  Some studies suggest that only one in 12 women with SUI feel comfortable enough to discuss the problem with their doctor.1  Most suffer in silence for several years before asking for help.

Today, however, the condition is very treatable for patients of any age.

A minimally invasive, 30-minute surgical procedure can be performed on a day-surgery basis that is highly effective.  Post-operative recovery is minimal and patients can go home almost immediately after the surgery is completed.

"Patients can go back to work 48 hours after the surgery," says Dr. Richard Kalbfleisch, a Urogynecologist with the Wentworth-Limeridge Medical Centre in Hamilton, Ontario.  "I have even had patients go jogging 48 hours after the surgery."

SUI frequently occurs because the pelvic floor muscle has become weakened and cannot support the urethra in the normal position.  This causes urine to leak out involuntarily.  To correct this condition, a surgeon inserts Sub-Urethral Sling (SU-Sling) - a ribbon-like mesh - under the urethra to provide support, allowing the urethra to remain closed and prevent involuntary urine loss.  This helps the body stop urine leakage, the same way the body was designed to do it:  by supporting the urethra.

Not only do many sufferers find SUI too embarrassing to talk about with their doctors, many who did ask for help were dissuaded in the past by complicated surgical procedures.  The introduction of the SU-Sling, and the surgical refinements made possible by its use, have reduced the procedure to a more minimal operation.

"The (SU-Sling) procedures have revolutionized the treatment of stress urinary incontinence in women," says Dr. Kalbfleisch.  "Not only is it safe and effective, the patients love it over the (previous) procedure.  Now that the surgery is minimally invasive, more patients with the problem are stepping forward."


Technology Overview

A Sub-Urethral Sling is a fine mesh ribbon used to support the urethra and allow the body's muscles to control the flow of urine normally.  Modern techniques for using the Sling require few external incisions.  A surgeon makes up to four small incisions, either in the abdomen, thigh, or within the vagina (depending on which specific product is used) and inserts the tape using local or regional anesthesia in a day-surgery setting.  There is virtually no post-operative pain and most patients return to normal activities within 48 hours.

fast facts

  • Up to 3.3 million Canadians (10 per cent of the population) experience some form of incontinence.1
  • Urinary incontinence is the most common cause of admission to long-term institutional health care centres in Canada.1
  • 90% of patients with Stress Urinary Incontinence are women.3
  • Up to 98% of women treated with the SU-Sling are symptom-free 7 years later.4
  • SU-Sling procedure:
    • Minimally invasive
    • Normally, same-day discharge
    • Normally, no post-op catheterization
    • Fast return to normal activities
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