Mid-Urethral Slings

Urethral Sling for Stress Incontinence in Women
Surgery Overview

Urethral sling surgeries to treat urinary incontinence involve placing a sling around the urethra to lift it back into a normal position and to exert pressure on the urethra to aid urine retention. The sling is attached to the abdominal wall.
The sling material may be muscle, ligament, or tendon tissue taken from the woman or from an animal, such as a pig. It may also be composed of synthetic material such as plastic that is compatible with body tissues or of absorbable polymer that eventually disintegrates.
What To Expect After Surgery

These surgeries involve deep incisions, so hospitalization is required. To allow the urinary tract to heal, a thin, flexible tube (catheter) is placed into the bladder through the urethra or abdominal wall to allow urine to drain.
You will likely go home 2 to 3 days after the surgery if there have been no complications. After you are at home, expect a 2- to 4-week recovery period, during which you should refrain from doing too much work or strenuous activities of any kind.
The amount of pain you have after surgery depends on the exact nature of your procedure, your physical condition at the time of surgery, and your own response to pain. You will probably feel some pain at the incision site and may feel some cramping in the abdomen. Your doctor will prescribe medicine to relieve your discomfort during the first few days after surgery. Be sure to call your doctor if you cannot get relief from pain.
Many women have some constipation after this surgery. You can try some things to avoid constipation:
Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fiber.
Drink plenty of fluids, enough so that your urine is light yellow or clear like water.
Take a fiber supplement, such as Citrucel or Metamucil, every day if needed. Start with a small dose and very slowly increase the dose over a month or more.
Schedule time each day for a bowel movement. Having a daily routine may help. Take your time and do not strain when having a bowel movement.
Tell your doctor if you still have constipation after you have tried these methods.
Why It Is Done

The urethral sling procedure may be used for women who have stress incontinence:

Caused by sagging of the urethra and/or bladder neck.
With a history of previous failed surgeries.
Complicated by factors such as obesity that create a risk for failure of other types of surgeries.
Caused by problems with the muscular outlet of the bladder (sphincter).
How Well It Works

Sling surgeries are as effective as other surgeries to cure stress urinary incontinence in women. About 8 out of 10 women are cured after this surgery.

Complications of urethral sling surgery may include:
Difficulty urinating after surgery.
New symptoms of urgency or urge incontinence.
Injury to an organ (such as the bladder, urethra, or ureters).
Internal bleeding.
Infection at the incision site.
All surgeries that use general anesthesia carry a small risk of complications or death.
What To Think About

The urethral sling procedure is more complicated than the other surgical methods for correcting stress incontinence and involves a greater risk of damage to the urethra. It is sometimes done after other surgery for stress incontinence has failed.
Using a woman’s own tissue for sling material eliminates problems with rejection of the sling. It also reduces the risk of the wearing away (erosion) of the urethra or vagina. But using a woman’s own tissue increases surgery time and increases the number of incisions required. This is because the sling tissue must be taken from the woman’s body.
Before having surgery for urinary incontinence, ask your doctor about the following:
How much success has the doctor had in treating incontinence with surgery? The success of surgical procedures for urinary incontinence depends on the experience and skill of the surgeon.
Is there anything you can do to increase the likelihood of a successful surgery? Losing weight, quitting smoking, or doing pelvic floor (Kegel) exercises prior to surgery may increase the likelihood of regaining continence after surgery.