Urinary incontinence - vaginal sling procedures
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 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.
Pubo-vaginal sling; Transobturator sling
Vaginal sling procedures use different materials:
- Tissue from your body
- Tissue from the body of a person who has died (cadaver tissue)
- Tissue from a pig or cow
- 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.
Why the Procedure Is Performed
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:
- 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:
- 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 vagina and the skin
- 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 health care provider 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), 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 provider can help.
On the day of the surgery:
- You will likely 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.
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.
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.
Appell RA, Dmochowski RR, Blaivas JM, Gormley EA, et al. Female Stress Urinary Incontinence Update Panel of the American Urological Association Education and Research. Update of AUA guideline on the surgical management of female stress urinary incontinence. J Urol. 2010;183:1906-14. PMID: 20303102 www.ncbi.nlm.nih.gov/pubmed/20303102.
Dmochowski RR, Padmanabhan P, Scarpero HM. Slings: autologous, biologic, synthetic, and midurethral. In: Wein AJ, Kavoussi LR, Novick AC, et al., eds. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 73.
Wai CY. Surgical treatment for stress and urge urinary incontinence. Obstet Gynecol Clin North Am. 2009;36:509-19. PMID: 19932413 www.ncbi.nlm.nih.gov/pubmed/19932413.