The female mid-urethral sling is a minimally invasive, outpatient procedure to treat stress urinary incontinence. This surgery has been performed sing the mid 1990's and has been shown to be safe and effective. The sling lies under the urethra acting as a “hammock” which maintains urethral support and keeps it closed during abdominal pressure increases (as with a cough, sneeze, or athletic activity), preventing loss of urine.
The female sling is a short (15-30 minute) outpatient surgery done under general anesthesia, spinal anesthesia or under sedation with local anesthesia. A 2-3 cm (1 inch) incision is made in the vagina as well as 2 mini incisions just above the pubic bone or in the inner thigh just beside the labia. In some cases only a single vaginal incision is made. The sling, made of surgical mesh (polypropylene), is then placed under the urethra and brought out through the mini incisions using specially designed instruments. The sling is then adjusted to the proper tension (no pressure on the urethra) and then buried under the skin incision after excess mesh is removed. The incisions are closed with dissolvable sutures. Patents usually go home within a few hours after surgery.
Information about postoperative care can be found below.
The primary aim is to improve the severity of stress urinary incontinence to a satisfactory level. Most patients (90% or more) will achieve this goal. Some of these patients (about 70-80%) are completely dry. Please note that this surgery is not designed to treat overactive bladder or urge incontinence (see Incontinence Overview for more information about this). In some cases of mixed incontinence, one may eperience an improvement in both stress and urge-related leakage events - usually these patients have a unique condition where the urge incontinence is triggered by stress incontinence episodes.
In general, the rate of any serious complication is very low (less than 2% overall) making the risk-benefit profile of this surgery highly favorable. Potential risks include:
If you have questions that are not answered here, please contact us.
You will begin a voiding trial immediately following surgery. You should void every 2-3 hours. If unable to void you should perform self-catheterization if you have been taught how. Keep track of voided and/or catheterized volumes. If you have not been taught self-catheterization and cannot void you will need to go to your nearest hospital emergency room for a catheter to be placed.
If you have an indwelling catheter please see catheter care instructions.
Urinary frequency, urgency and a slower urine stream may occur in the first 1-2 weeks.
Vaginal bleeding similar to a light period is expected for 1-2 weeks.
May experience pain or discomfort around incision sites.
You may experience inner thigh discomfort.
Report any of the following to your doctor: