Urinary incontinence - urethral sling procedures

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 doctor 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 doctor 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.

Vaginal sling procedures are done to treat stress urinary incontinence.

Before discussing surgery, your doctor 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 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

Tell your doctor what medicines you are taking. These include medicines, supplements, or herbs you bought without a prescription.

During the days before the surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, warfarin (Coumadin), and any other medicines that make it hard for your blood to clot.
• Ask which medicines you should still take on the day of the surgery.
• If you smoke, try to stop. Your health care provider can help.

On the day of the surgery:

• You may be asked not to drink or eat anything for 6 to 12 hours before the surgery.
• Take the medicines you have been told to take with a small sip of water.
• You will be told when to arrive at the hospital. Be sure to arrive on time.

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.

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.

Pubo-vaginal sling; Transobturator sling; Midurethral sling

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.

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.

Updated 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.