A sling helps some patients manage urinary incontinence.
It’s perfectly normal to have occasional moments when coughing or enjoying a hardy laugh leads to an unexpected urine leak. But when what’s termed urinary incontinence becomes a regular occurrence, you may need to see a urologist.
Since weak pelvic floor muscles often contribute to stress incontinence, which is more likely to affect women, conservative treatments involving medication and therapeutic exercises are among the most common treatment suggestions.
If such efforts fail to reduce urine leaks, sling procedures may be recommended.
A “sling" refers to the mesh or synthetic material that’s used to provide additional support where the urethra (urine tube) connects to the bladder, also known as the bladder neck. Stress incontinence is the type of UI that’s often treated with sling procedures.
Conventional Sling Procedures
A traditional approach to sling surgery involves an incision in the vagina to place the sling material by the bladder neck. An additional abdominal incision is made to pull the sling material into the correct position and create the right amount of tension. The sling material is either partly attached to the fascia (pelvic tissue) or directly to the wall of the abdomen.
How Are Tension-Free Slings Different?
The most notable difference is that tension-free sling procedures are done with smaller incisions. Also, body tissue holds the sling material in place, eliminating the need for stitches to achieve this goal. Eventually, scar tissue forms to firmly keep the sling in the correct position. There are three options with tension-free slings:
Retropubic: With this procedure, the incision is made in the vagina below the urethra. Two additional openings are made by the pelvic bone for the needle that’s used to insert the sling material into place. The incisions are sealed or stitched shut.
Transobturator: This type of tension-free sling procedure involves a similar process. A different pathway near the vagina is used to put the sling material into place.
Single-incision mini: When this procedure is performed, only one incision in the vagina is needed to insert the sling material and position it correctly. No additional incisions are necessary.
What Happens Post-Surgery?
Following sling surgery, you should be able to get back to work and resume your normal routine after you’ve healed. With tension-free procedures, recovery periods are usually shorter. Your surgeon will check the incision site(s) and examine the bladder. It’s normal to have some slight leakage until scar tissue develops to fully support the sling material with tension-free procedures. If symptoms of urinary incontinence continue, a visual examination of the bladder with a lighted scope (cystoscopy) may be done to determine if the sling material is in the correct position.
Should sling procedures not provide sufficient relief from urinary incontinence symptoms, a urologist may suggest the surgical insertion of an electrical stimulation device to change how nerve signals are sent from the bladder to the brain; or the bladder neck and urethra may be reinforced with a bladder neck suspension procedure. Another type of surgery that’s sometimes performed is a “bladder lift" (Burch colposuspension) to elevate the bladder slightly to an area with stronger ligaments.