In 2019, the FDA ordered manufacturers to stop selling surgical mesh intended for the transvaginal repair of pelvic organ prolapse. That order did not prohibit mesh slings used to treat stress urinary incontinence.
The two procedures are sometimes grouped together because both may involve polypropylene mesh and placement through a vaginal incision. However, they treat different conditions and use different amounts and configurations of mesh.
Women who have both bladder leakage and a vaginal bulge or pressure may have more than one pelvic-floor condition. Read more about the symptoms and treatment of pelvic organ prolapse.
What Types of Bladder Sling Surgery Are Available?
Several sling procedures can be used to treat stress incontinence.
Retropubic midurethral sling
The surgeon makes a small vaginal incision and usually two small incisions near the lower abdomen. The sling passes behind the pubic bone and beneath the urethra.
Transobturator midurethral sling
The sling passes through the obturator area toward small incisions near the groin or upper thigh. This approach follows a different path around the pelvis than a retropubic sling.
Single-incision or “mini” sling
A shorter piece of mesh is inserted through one vaginal incision. Availability and recommendations can vary based on the patient, surgeon, and specific product.
Autologous fascial sling
Instead of synthetic mesh, the surgeon uses a strip of the patient’s own tissue, usually taken from the abdominal wall or thigh. This avoids a permanent synthetic mesh implant but generally requires a larger operation and an additional surgical site.
A surgeon may also discuss non-sling operations, such as Burch colposuspension, depending on your medical history and preferences.
How Effective Is Bladder Sling Surgery?
Midurethral sling surgery is one of the most extensively studied surgical treatments for stress urinary incontinence. Many women experience substantial improvement, and professional medical organizations recognize it as an accepted surgical option.
The American Urogynecologic Society reports that more than 90% of women are satisfied with the outcome of midurethral sling surgery. However, individual results vary, and surgery does not guarantee that all leakage will stop.
A sling is intended to treat stress incontinence. It may not improve urgency, frequent urination, or leakage preceded by a sudden urge. If you experience both stress and urge leakage, you may have mixed urinary incontinence and could need more than one treatment approach.
What Are the Risks of Bladder Sling Surgery?
All surgical procedures involve risk. General surgical complications include bleeding, infection, reactions to anesthesia, and injury to nearby organs, nerves, or blood vessels.
Possible complications associated with bladder sling surgery include:
- Temporary difficulty emptying the bladder
- Need for short-term catheter use
- Urinary tract infection
- New or worsening urinary urgency
- Continued or recurring stress incontinence
- Pain in the pelvis or groin
- Pain during sexual intercourse
- Vaginal bleeding or discharge
- Mesh exposure through vaginal tissue
- Mesh erosion into the bladder, urethra, or another nearby organ
- Need for another procedure to adjust or remove the sling
The American Urogynecologic Society notes that temporary catheter use after surgery is usually limited to a few days. Chronic pain or pain during sex related to mesh tension may occur in 1% or fewer patients, although complications can be difficult to treat when they do occur. Review the organization’s midurethral sling patient checklist.
Because tissue grows around an implanted mesh sling, removing it can be more complicated than placing it. Removal may improve symptoms, but it does not guarantee that pain or other problems will completely resolve.
Contact your healthcare provider if you have persistent pelvic or groin pain, vaginal bleeding or discharge, pain during sex, recurrent urinary infections, difficulty urinating, or new bladder symptoms after sling surgery.
What Is Recovery From Sling Surgery Like?
Sling surgery is commonly performed as an outpatient procedure, although individual recovery depends on the surgical approach and the patient’s health.
During the first several days, you may experience discomfort, light vaginal bleeding, fatigue, or difficulty emptying your bladder. Some patients temporarily need a catheter.
Your surgeon may restrict:
- Heavy lifting
- Strenuous exercise
- Running or high-impact activity
- Vaginal intercourse
- Tampon use
Restrictions often remain in place for several weeks while the incision heals and the sling becomes incorporated into the surrounding tissue. Follow your surgeon’s specific instructions rather than returning to activity based only on how you feel.
Ask in advance when you can return to work, drive, exercise, lift children or other heavy objects, and resume sexual activity.
Who May Be a Candidate for Sling Surgery?
Sling surgery may be considered when stress incontinence significantly affects daily life and conservative treatment has not provided enough improvement.
Before recommending surgery, a clinician should confirm that leakage is primarily caused by stress incontinence. Urgency incontinence, urinary retention, overflow incontinence, infection, and other bladder conditions may require different treatment.
Factors to discuss with your clinician include:
- The type and severity of your leakage
- Treatments you have already tried
- Whether you also experience urgency or frequent urination
- Previous pelvic surgery
- Pelvic organ prolapse
- Plans for a future pregnancy
- Your comfort with a permanent implant
- Your ability to accommodate surgical recovery
- Your personal goals and tolerance for risk
Future pregnancy and vaginal delivery may cause stress incontinence to return, so women planning additional pregnancies may be advised to delay surgery.
What Are the Alternatives to Bladder Sling Surgery?
Not every woman with stress incontinence needs surgery. The FDA recommends discussing both surgical and nonsurgical options before making a decision.
