Tying the suture at each end should not strangulate the fascia. The retropubic space is developed carefully and previous suspension should be taken down. Cystourethrolysis is performed so as to feel the back of the symphysis pubis, the balloon of the Foley's catheter and the paravaginal fascia without difficulty. This is an important step to free the vesicourethral segment from adhesions that would prevent the bladder neck from coating during stress. Also, the tip of the suture carrier needle can be guided to the paravaginal space safely without transfixing the bladder wall.
Vaginal dissection is facilitated by saline infiltration.
The endopelvic fascia is detached from its attachment to arcus tendinous under the pubic bone just enough to admit a finger into the retropubic space. A Stamey or Raz suture carrier needle is passed through suprapubic incision on each side and guided into the vaginal space. The sling is then centered behind the posterior urethra and bladder neck. Closure of the anterior vaginal wall is performed using chromic catgut suture in a continuous interlocking manner. The rectus fascia is closed by a continuous PDS suture.