The AUA believes that these four types of surgery have important differences. According to the AUA, retropubic suspensions are performed through an incision in the lower abdomen. In this procedure, sutures are placed near the bladder neck and urethra, and secured to a pelvic bone or to surrounding supporting structures. Transvaginal suspensions are described by the AUA as being performed through the vagina and through a small incision in the lower abdomen. Sutures are placed in the tissue near the bladder neck and urethra from the vaginal side, then the sutures are transferred to the abdominal incision.
Anterior repairs address vaginal support of the bladder base by using the pubocervical fascia.
Sling procedures are performed partly through the vagina and partly through a small incision similar to the incision for a transvaginal suspension. This procedure creates a hammock-like bolstering of the urethra. A supporting strip of material is placed under the urethra and bladder neck, and secured with permanent suture to the abdominal wall or a pelvic bone. The data indicate that after 48 months, retropubic suspensions and slings appear to be more effective than transvaginal suspensions and anterior repairs. The cure rate for each of these two procedures is about 85 percent, compared with cure rates of 67 percent in transvaginal suspensions and 61 percent in anterior repairs.