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

To address the lack of standardized procedures for concurrent stress urinary incontinence (SUI), cystocele, and vaginal laxity, we developed a novel, integrated approach that employs a customized inverted T-shaped sling for bladder neck-to-midurethral suspension combined with modified posterior pelvic reconstruction. The widened sling design with posteriorly shifted suspension vector prevents postoperative voiding dysfunction associated with traditional slings. The modified reconstruction technique employs high-strength absorbable barbed sutures for bilateral levator ani plication and perineal body reinforcement, which reduces urogenital hiatus dimensions, corrects vaginal laxity, and prevents long-term recurrence through the enhanced level III support. A 46-year-old woman with concomitant SUI, stage II cystocele (according to the Pelvic Organ Prolapse Quantification system), and vaginal laxity successfully underwent the procedure. Magnetic resonance imaging performed 6 months portsurgery confirmed adequate bladder repositioning. During the 24-month follow-up, SUI symptoms were resolved, pelvic / perineal discomfort diminished, and vaginal laxity during intercourse improved. This technique appears to represent a feasible single-stage solution for women presenting with concurrent SUI, cystocele, and vaginal laxity, providing comprehensive anatomical and functional restoration.