Urinary incontinence - urethral sling procedures
Definition
Vaginal sling procedures are types of surgeries that help control stress urinary incontinence. This is urine leakage that happens when you laugh, cough, sneeze, lift things, or exercise. The procedure creates a sling for your urethra that helps close your urethra and bladder neck. The urethra is the tube that carries urine from the bladder to the outside. The bladder neck is the part of the bladder that connects to the urethra.
Alternative Names
Pubo-vaginal sling; Transobturator sling; Midurethral sling
Description
Vaginal sling procedures use different materials:
- Tissue from your body
- Man-made (synthetic) material known as mesh
You have either general anesthesia or spinal anesthesia before the surgery starts.
- With general anesthesia, you are asleep and feel no pain.
- With spinal anesthesia, you are awake, but from the waist down you are numb and feel no pain.
A catheter (tube) is placed in your bladder to drain urine from your bladder.
The surgeon makes one small surgical cut (incision) inside your vagina. Another small cut is made just above the pubic hair line or in the groin. Most of the procedure is done through the cut inside the vagina.
The surgeon creates a sling from the tissue or synthetic material. The sling is passed under your urethra and bladder neck and is attached to the strong tissues in your lower belly, or left in place to let your body heal around and incorporate it into your tissue.
Why the Procedure Is Performed
Vaginal sling procedures are done to treat stress urinary incontinence.
Before discussing surgery, your health care provider will have you try bladder retraining, Kegel exercises, medicines, or other options. If you tried these and are still having problems with urine leakage, surgery may be your best option.
Risks
Risks of any surgery are:
- Bleeding
- Blood clots in the legs that may travel to the lungs
- Breathing problems
- Infection in the surgical cut or opening of the cut
- Other infection
Risks of this surgery are:
- Injury to nearby organs
- Breaking down of the synthetic material used for the sling
- Erosion of the synthetic material through your normal tissue
- Changes in the vagina (prolapsed vagina)
- Damage to the urethra, bladder, or vagina
- Abnormal passage (fistula) between the bladder or urethra and vagina
- Irritable bladder, causing the need to urinate more often
- More difficulty emptying your bladder, and the need to use a catheter
- Worsening of urine leakage
Before the Procedure
Tell your surgeon or nurse if:
- You are or could be pregnant
- You are taking any medicines, including medicines, supplements, or herbs you bought without a prescription
- You have been drinking a lot of alcohol, more than 1 or 2 drinks a day
Planning for your surgery:
- If you have diabetes, heart disease, or other medical conditions, your surgeon may ask you to see the provider who treats you for these conditions.
- If you smoke, it's important to cut back or quit. Smoking can slow healing and increase the risk for blood clots. Ask your provider for help quitting smoking.
- If needed, prepare your home to make it easier to recover after surgery.
- Ask your surgeon if you need to arrange to have someone drive you home after your surgery.
During the week before your surgery:
- You may be asked to temporarily stop taking medicines that keep your blood from clotting. These medicines are called blood thinners. This includes over-the-counter medicines and supplements such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and vitamin E. Many prescription medicines are also blood thinners.
- Ask your surgeon which medicines you should still take on the day of surgery.
- Let your surgeon know about any illness you may have before your surgery. This includes COVID-19, a cold, flu, fever, herpes breakout, or other illness. If you do get sick, your surgery may need to be postponed.
On the day of surgery:
- Follow instructions about when to stop eating and drinking.
- Take the medicines your surgeon told you to take with a small sip of water.
- Follow instructions on when to arrive at the hospital. Be sure to arrive on time.
After the Procedure
You may have gauze packing in the vagina after surgery to help stop bleeding. It is most often removed a few hours after surgery or the next day.
You may leave the hospital on the same day as surgery. Or you may stay for 1 or 2 days.
The stitches (sutures) in your vagina will dissolve after several weeks. After 1 to 3 months, you should be able to have sexual intercourse without any problems.
Follow instructions about how to care for yourself after you go home. Keep all follow-up appointments.
Outlook (Prognosis)
Urinary leakage gets better for most women. But you may still have some leakage. This may be because other problems are causing urinary incontinence. Over time, the leakage may come back.
References
Gomelsky A, Dmochowski RR. Slings: autologous, biologic, synthetic, and midurethral. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 125.
Kobashi KC, Vasavada S, Bloschichak A, et al. Updates to surgical treatment of female stress urinary incontinence (SUI): AUA/SUFU Guideline (2023). J Urol. 2023;209(6):1091-1098. PMID: 37096580 pubmed.ncbi.nlm.nih.gov/37096580/.
Lentz GM, Miller JL. Lower urinary tract function and disorders: physiology of micturition, voiding dysfunction, urinary incontinence, urinary tract infections, and painful bladder syndrome. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 21.
Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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