Mesh sling procedures, sometimes [mistakenly] called “bladder slings” or TVT, are surgical procedures that involve support of the middle portion of the female urethra. They were developed in the early 1990s and act as a sling or hammock to prevent the urethra from excessive movement during activity such as laughing, coughing, sneezing, or exercise. They have been used worldwide for nearly 30 years to treat this type of urine leakage and are very effective. Like any surgery, however, a mid urethral sling has risks and the decision to undergo this treatment should be a discussion between a patient and her surgeon.
Midurethral slings are thin strips of mesh material under the urethra (the tube that drains the urine from bladder). Most often, these thin strips of material are made of a plastic (polypropylene) — think of a 1/2″ ribbon knitted from fishing line. The mesh, placed during an outpatient procedure, is meant to replicate the normal support that is provided to the urethra; support that is often weakend with age, chronic straining, pregnancy, and childbirth.
It is important to know that a mid urethral sling only helps with stress urinary incontinence and does not help with urinary incontinence associated with a sense of urgency (urge incontinence) or overactive bladder (OAB).
Thankfully, stress urinary incontinence is not dangerous and, as such, does not need to be treated emergently. Because of this, there are many options to treat stress urinary incontinence that range from very safe to moderate risk. These include:
In addition to mesh sling surgery, there are non-mesh surgeries for stress urinary incontinence. These surgeries often include using grafts that can be harvested from the patient, a non-living donor, or other animal (pig is the most common). Unlike synthetic slings which are placed at the mid urethra, these types of slings are often placed at the bladder neck. Depending on your goals, your anatomy, and the type/severity of your symptoms, you may be a candidate for a surgery called a Burch procedure in which the vaginal wall near the urethra is attached to a ligment on the pubic bone using sutures/stitches. Finally, urethral bulking procedures are very safe, well tolerated, and minimally invasive.
Midurethral sling surgery can be safely and effectively used for stress urinary incontinence. Studies show their effectiveness compared to the older more traditional forms of stress-incontinence procedures (such as a Burch colposuspension, traditional sling surgery, and pubovaginal sling). Mid-urethral sling is less-invasive than these procedures, causing shorter hospital stays and faster recovery times. The material used (polypropylene) has been surgically implanted for over 5 decades in the form of suture and mesh across nearly every surgical specialty.
The most common risks/complications are:
The midurethral sling is the most studied surgical procedure for stress incontinence and has been used to treat millions of women since it was first introduced in the early 1990s. Approximately 80% of women who undergo a midurethral sling surgery have no stress urine leakage after the surgery and 95% of patients are satisfied with the procedure. Approximately 20 years of safety data is very reassuring . Because polypropylene is a permanent implant, the device works to prevent stress incontinence for a long time.
Retropubic midurethral slings for urinary stress incontinence were first described in 1993 and came to market in the United States around 1996.
After talking with your surgeon about your symptoms, your medical history, and other surgery you have had in the past, you may decide that a surgical approach using a synthetic material ( midurethral sling) is the best option for you. A midurethral sling is almost always done as an outpatient procedure.
Immediately prior to surgery, you will receive an antibiotic to decrease your risk of infections. After the anesthesiologist gets you sleepy, a flexible tube called a catheter will be placed in the bladder and numbing medication will be injected at the surgical site. A small incision (about an inch) will be made in the front wall of the vagina under the urethra. Depending on the type of sling that you and your doctor decided on, you may also have two small incisions near the pubic bone (retropubic slings) or in the groin/inner thigh (transobturator slings).
The sling is then passed under the skin and near the bones of the pelvis. Your doctor will then place a camera in the bladder and the urethra to be sure they were not harmed by the surgery before anchoring the sling in place. The incisions are then closed with stitches and the tube in the urethra will, in most cases, be removed in the operating room or the recovery room. Occasionally, packing (similar to a large tampon) will be placed in the vagina.
Most patients do not require a hospital stay. There is some risk that you will have difficulty urinating after the surgery (about 1 in 3 women do) and will need to use a catheter for a few days after the surgery. In rare cases (1 in 50), this difficulty urinating lasts longer and may require further treatment.
Most women who have a sling experience some pain and discomfort for a couple of weeks after the surgery though it is hard to predict how much pain any particular person will have. At times the urine will be pink-tinged and urination will be uncomfortable for a couple of days. If this does not improve a little every day, you should notify your surgeon.
After a sling, physical activity is largely restricted by pain or discomfort in the pelvis and vagina. Your surgeon will have specific restrictions, especially when it comes to lifting or sexual activity.
The decision to have a mid urethral sling surgery is a very personalized one. As with any procedure, mesh slings come with certain risks and benefits. Only after weighing the benefits against the risks can your doctor help you make the decision regarding surgery for stress incontinence.
Schedule an appointment or call us today to discuss the many treatment options available for urinary incontinence, pelvic organ prolapse and a variety of other bothersome pelvic health symptoms. We aim to provide quality, convenient, low-stress care to women throughout the Midwest.
