T‑shaped sling with modified posterior pelvic reconstruction: a technical note with video vignette

Area of Science:

• Urogynecology
• Pelvic Reconstructive Surgery

Background:

• Lack of standardized procedures for concurrent stress urinary incontinence (SUI), cystocele, and vaginal laxity.
• Need for integrated surgical solutions addressing multiple pelvic floor disorders.

Purpose of the Study:

• To present a novel, integrated surgical approach for simultaneous correction of SUI, cystocele, and vaginal laxity.
• To evaluate the feasibility and efficacy of this single-stage procedure.

Main Methods:

• Development of a customized inverted T-shaped sling for bladder neck-to-midurethral suspension.
• Modified posterior pelvic reconstruction utilizing high-strength absorbable barbed sutures for levator ani plication and perineal body reinforcement.
• Single-stage surgical correction in a patient with concomitant SUI, stage II cystocele, and vaginal laxity.

Main Results:

• Successful anatomical restoration confirmed by MRI showing adequate bladder repositioning at 6 months post-surgery.
• Complete resolution of SUI symptoms and diminished pelvic/perineal discomfort at 24 months follow-up.
• Significant improvement in vaginal laxity during intercourse reported by the patient.

Conclusions:

• The novel integrated surgical technique appears to be a feasible single-stage solution for concurrent SUI, cystocele, and vaginal laxity.
• This approach provides comprehensive anatomical and functional restoration, addressing multiple pelvic floor defects effectively.
• The widened sling design and modified reconstruction enhance pelvic support and prevent recurrence.