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Sling surgery (stress urinary incontinence surgery) is a common surgery used for stress urinary incontinence, a form of incontinence that occurs when you put any type of pressure on your bladder. Your consultant creates a hammock-like “sling” (mesh) and places it under your urethra, to provide support, and so prevents urine leaking from your bladder.
The urethra is the tube that urine passes through when it’s exiting your body.
What is stress urinary incontinence?
Stress urinary incontinence is when you involuntarily leak pee when you sneeze, cough, lift, laugh or exercise. It is very common in women.
Treatments includes lifestyle changes (weight loss, stopping smoking and avoiding constipation) and pelvic floor exercises to reduce the number of leaks. If these don’t work, then surgery may be considered.
- Stopping smoking several weeks before a surgery reduces your chances of complications such as infection, blood clots and poor healing and improves your overall health.
- You may need to stop taking blood thinning medication such as Aspirin, Plavix (clopidogrel), warfarin (coumadin) or Xarelto (rivaroxaban) –please inform the consulting doctor if you are taking any of these.
- Try to maintain a healthy weight.
- Optimise your blood sugars if you are diabetic.
- Avoid becoming constipated.
You will be given a general anaesthetic or in some cases a spinal anaesthetic before the operation.
During the operation you will be given antibiotics through one of your veins to reduce the chance of infection.
A catheter (draining tube) will be put in place to allow your bladder to be emptied overnight.
There are two types of mid-urethral sling operations and the type chosen for you will depend on your personal circumstances and will be discussed with you before your operation.
- The transvaginal tape operation: this approach uses one small cut (2-3 cm) in your vagina and two small cuts in your lower stomach just above your pubic bone.
- The transobtuator tape operation: this approach entails one small cut (2-3cm) in your vagina and a second and third small cut on your inner thigh on both sides.
A cystoscopy is also carried out during the procedure to make sure that there has been no injury to your bladder or urethra.
You will normally stay overnight in hospital following the surgery. Your recovery will be monitored, and you will be allowed to drink and eat. The nurses will monitor the amount of urine you pass and will scan your bladder after you have gone to the toilet to check that it is empty.
You will have a small discharge/bleeding from your vagina for a few days, if the bleeding persists or gets heavier let your doctor know. The use of tampons, and sexual intercourse, should be avoided completely during the first six weeks after your operation. Your consultant will advise you when to attend for a check-up in the weeks following surgery and if you are fully recovered, you will be able to resume your normal activities.
In general, avoid straining passing a bowel motion, do not do any heavy lifting and avoid constipation after surgery as these are associated with increased risk of recurrent incontinence.
It is successful in 80-90% women. 94/100 sees some improvement in bladder control.
Whilst no surgery is without risk serious complications with this type of surgery are rare. The main potential complications are:
- Voiding dysfunction: about 4% of all women initially have problems with fully emptying the bladder. This is usually only last for up to 7 days. However, if it persists an operation may be required to loosen or cut the mesh.
- New-onset urgency and/or urge incontinence: 3% to 15% of women have to rush to the toilet and may leak before getting there.
- Injury to internal organs: there is a very small risk of damage to internal organs (your bladder, ureters, urethra, bowel and blood vessels are all close together) requiring further surgery.
- Bleeding: major bleeding during or after the surgery is uncommon (1%) but may require a blood transfusion
- Infection or rejection: <1% risk of the mesh becoming infected or rejected resulting in the need to remove it ; 1-5% risk of wound infection or urinary tract infection
- Clots: <1% risk of blood clots in the legs or lungs
- There are also individual risks with a general anaesthetic which are outlined preoperatively by the anaesthetist.