Urinary incontinence is a problem that affects approximately 25 million Americans.
This “urge to go" disorder that can sometimes result in leaks at the wrong moments is often treatable with medications, special exercises that target pelvic and bladder muscles, and injections to tighten bladder wall muscles. If these attempts at improving bladder control aren’t effective, a urologist may discuss sling procedures with you.
The purpose of sling surgery is to provide extra support around the urethra at the point where it connects to the bladder, referred to as the bladder neck. Made with a patient’s own body material, mesh, or synthetic material, slings help keep the urethra closed to prevent urine leakages.
Tension-free slings are so-named because the sling is supported by the body without stitches. Support will increase as scar tissue naturally forms where the sling is placed. There are three main types of tension-free slings.
With single-incision slings, the synthetic mesh used with these slings is inserted through an incision in the vagina. Also inserted through an incision in the vagina, a retropubic sling also requires additional incisions by the pubic bone for the needle needed to put the sling into the correct position.
A transobturator sling is a similar piece of material that’s inserted with smaller vaginal incisions. The needle is inserted with openings near the labia. All openings needed for tension-free slings are surgical sealed or stitched.
How Do They Differ from Conventional Slings?
With a traditional or conventional sling procedure, larger incisions are made to reach the area where the sling material will be placed. Most conventional sling procedures require two incisions.
One is made in the vagina to insert the sling material by the opening of the bladder by the urethra. The other incision is made in the lower abdomen to create the right amount of tension on the newly inserted sling. With conventional surgery, stitches are used to attach the sling material. It may be attached to tissue in the pelvis, or directly to the abdominal wall.
What Is a Mini-Sling?
The newest sling procedure is referred to as a mini-sling. It’s a less-invasive procedure that doesn’t require groin or abdominal incisions. The mesh tape is inserted with a single incision in the vaginal. The mesh material is placed in the middle of the urethra.
What Happens After Surgery?
Patients should be able to get back to their normal routine after a short healing period. Heavy lifting and exertion should be avoided during this time. Risks associated with most sling procedures are minimal. Follow-up visits to a urologist typically include a review of urination habits and an examination of the surgical site. If there is still some leakage, the bladder may be examined again with a special scope.
If sling surgery still isn’t completely preventing leaks, a bladder neck suspension may be done to provide added support for the urethra and bladder. Burch colposuspension is a common alternative to slings that’s done with sutures that lift the bladder up towards stronger, more supportive ligaments. For women with a combination of stress and urge incontinence, a sling procedure may be combined with prolapse surgery to further stabilize bladder and pelvic muscles.