leakage, however it is not clear how well these mechanical devices help women with stress urinary incontinence. Surgery Doctors usually suggest surgery to alleviate incontinence only after other treatments have been tried. Many surgical options have high rates of success. Less-invasive variants of the sling operation have been shown to be equally effective in treating stress incontinence as surgical sling operations. One such surgery is urethropexy. Insertion of a sling through the vagina (rather than by opening the lower abdomen) is called intravaginal slingplasty (IVS). Slings The procedure of choice for stress urinary incontinence in females is what is called a sling procedure. A sling implant usually consists of a synthetic mesh material in the shape of a narrow ribbon but sometimes a biomaterial (bovine or porcine) or the patients own tissue that is placed under the urethra through one vaginal incision and two small abdominal incisions. The idea is to replace the deficient pelvic floor muscles and provide a backboard of support under the urethra. Transvaginal mesh has recently come under scrutiny due to controversy relating to the Food and Drug Administration. Initially, the FDA approved implantable mesh devices due to their similarity to earlier prototypes, known as the 510(k) process. As patients allege long-term harm and suffering as a result of implanted mesh; the FDA released a safety communication in 2008, and led to the reclassification of surgical mesh to a class 3 or high risk device in January 2016. Insertion of a sling through the vagina (rather than by opening the lower abdomen) is called intravaginal slingplasty (IVS). Transobturator tape The transobturator tape (TOT or Monarc) sling procedure aims to eliminate stress urinary incontinence by providing support under the urethra. The minimally-invasive procedure eliminates retropubic needle passage and involves inserting a mesh tape under the urethra through three small incisions in the groin area. Midurethral tape A procedure that involves placing polypropylene tape under the outlet from the bladder to improve stress incontinence. Bladder repositioning Most stress incontinence in women results from the urethra dropping down toward the vagina. Therefore, common surgery for stress incontinence involves pulling the urethra up to a more normal position. Working through an incision in the vagina or abdomen, the surgeon raises the urethra and secures it with a string attached to muscle, ligament, or bone. For severe cases of stress incontinence, the surgeon may secure the urethra with a wide sling.