Methods and apparatus for securing and tensioning a urethral sling to pubic bone

An anchor adapted to be coupled to an implantable medical device having at least one device fixation element, the anchor comprising:

• an anchor body having a fixation end;
• and
• an elongated anchor line affixed at one line end to the anchor body and extending to an anchor line free end, and wherein:
• the anchor line comprises at least one line fixation element shaped to be fitted with the device fixation element to affix the medical device to the anchor.

A kit for implanting a urethral sling to support the urethra, the kit comprising:

• a urethral sling comprising a flexible sheet material extending between opposed first and second sling ends and bounded by opposed first and second sling sides;
• a plurality of anchors each comprising an anchor body having a fixation end and an elongated anchor line affixed at one line end to the anchor body and extending to an anchor line free end, the anchor lines adapted to be extended through the material of the urethral sling at selected locations displaced from the first and second sling ends;
• and
• a plurality of anchor line retainers having a retainer bore for receiving an anchor line, the retainer bore sized and shaped to be expanded to pass over the anchor line as the retainer is advanced toward the anchor and that resists retraction over the anchor away from the anchor,
• whereby the anchor line retainers may be selectively advanced to induce and retain stack in end portions of the urethral sling between the sling ends and the anchor line retainers, and tension in a central portion of the urethral sling disposed between the anchor line retainers and applied against the urethra.

A kit for implanting a urethral sling to support the urethra comprising:

• a urethral sling comprising a flexible sheet material having pores therethrough extending between opposed first and second sling ends and bounded by opposed first and second sling sides;
• and
• a plurality of anchors each comprising an anchor body having a fixation end and an elongated anchor line affixed at one line end to the anchor and extending to an anchor line free end, the anchor line free ends adapted to be extended through the pores of the urethral sling at selected pore locations displaced from the first and second sling ends to induce tension in a central portion of the urethral sling,
• wherein the anchor lines comprise at least one line fixation element that extends outward of the anchor line that expands pore size during advancement through the pore and bears against the material of the urethral sling and provides resistance to retraction of the fixation element through the pore.

A method of implanting a urethral sling to support the urethra comprising:

• providing a urethral sling comprising:
• a flexible sheet material extending between opposed first and second sling ends and bounded by opposed first and second sling sides;
• and
• at least one pre-positioned, plicating line having a plicating line length extending between first and second plicating line free ends and passed through the flexible sheet material at first and second points displaced from the respective first and second sling free ends such that an intermediate portion of the plicating line extends across a central portion of the urethral sling intermediate first and second end portions of the urethral sling;
• surgically affixing the first and second sling ends to extend across the urethra;
• drawing the plicating line free ends together to induce tension in the first and second end portions and apply tension across the central portion of the urethral sling;
• and
• tying the plicating line free ends.

A method of implanting a urethral sling to support the urethra comprising:

• providing a urethral sling comprising a flexible sheet material extending between opposed first and second sling ends and bounded by opposed first and second sling sides;
• providing bone anchors having a bone fixation end and an elongated bone anchor line affixed at one line end to the bone anchor and extending to an anchor line free end;
• affixing anchors, spaced from one another;
• attaching the sling first end to the affixed anchors;
• attaching the sling second end to the affixed anchors;
• and
• tensioning a central portion of the urethral sling by inducing a slack in the flexible fabric of the urethral sling in a first edge portion between the central portion and the first sling edge.