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Sling Procedures
Stress urinary incontinence (SUI) is leakage with physical activity. Here the word “stress” refers to physical stress or exertion, not “emotional stress”. In many instances of SUI, the pelvic floor, which supports the bladder, bladder neck and urethra, becomes weak due to pregnancy, childbirth, hormonal changes, aging, and/or prior pelvic surgery. This may lead to excessive movement of the urethra, i.e. hyper mobility, with physical stress maneuvers. Another cause of SUI is a weakened urethral sphincter, known as intrinsic sphincteric deficiency (ISD), in which the urethral sphincter becomes incapable of sealing the flow of urine during physical exercise.
Many experts believe that women with SUI and concomitant ISD should undergo either a sling-type procedure or an injection of bulking agents (collagen, carbon particles (Durasphere), Teflon, fat, silicon, copatite) around the bladder neck and proximal urethra. Patients with concomitant ISD and significant urethral hyper mobility may respond less favorably to bulking agents and are best treated with sling procedures.
Three categories of surgical techniques used to treat SUI are: retro pubic suspensions (more invasive); transvaginal bladder neck suspensions (less efficacious) ; and sling procedures to create hammock-like support of the urethra using synthetic material or abdominal fascia, thigh fascia or similar tissue derived from carefully processed cadaveric tissue. One of the most novel and exciting procedures is the use of a synthetic mesh made out of prolene to treat SUI. The technique is similar to other sub urethral “sling” devices. A supportive hammock of Prolene (a synthetic mesh) is placed under the mid portion of the urethra in a “tension-free” manner. The mesh is placed vaginally using minimal tissue dissection. A small puncture incision is placed below the pubic hair line on either side.
Frequently Asked Questions after Stress Incontinence Surgery
Typically the procedure will last 30 minutes to one hour. You might be in the operating longer to account for preparations
What can I expect during recovery?
You will likely have some vaginal spotting and drainage for 3-4 weeks. Heavy bleeding with large blood clots is not normal.
You may experience some (usually minimal) vaginal and suprpubic discomfort for 7 days. You may experience some burning on urination. If your catheter has been removed and you can’t empty your bladder, you should call the office. Approximately 5% of patients may experience this problem. You should not experience much change in your bowel function.
The same day of the surgery or the following morning.
When you feel you are ready. (Usually 3 days after surgery)
You should avoid lifting anything heavier than 10 lbs for 6 weeks. You may resume driving in 24-48 hours if you feel up to it and if you are not taking narcotic pain pills.
6 weeks after surgery
2-3 weeks after surgery
Urinary retention (5%), bleeding (<1%), bowel injury (<1%), injury to adjacent structures (1%), development of new urge related incontinence (7%), extrusion of the mesh in the vaginal canal (1-5 %).
80-90%. Note that if you have mixed incontinence (ie both stress and urge incontinence), you may have persistent urge incontinence in at least 50% of the cases.
