What Is Bladder Sling Surgery

Urinary Incontinence: Vaginal Sling Procedure

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Overview

The vaginal sling procedure is also called the pubovaginal sling procedure. Its a type of surgery used to treat urinary incontinence in women.

Urinary incontinence is the medical term for the inability to control your bladder. This condition leads to the leakage of urine. For example, you may experience urine leakage after coughing or sneezing. Or you may experience strong and sudden urges to urinate, which lead to urine leakage when you cant make it to a toilet in time. If you have severe urinary incontinence that affects your daily life, your doctor may recommend a vaginal sling procedure to treat it.

When you urinate, a circular-shaped muscle around your bladder relaxes and releases urine into your urethra. Your urethra is the tube that leads from your bladder to the outside of your body. In the vaginal sling procedure, your surgeon will use a piece of tissue or synthetic material to make a sling around your urethra. This will help keep your urethra closed and prevent urine leakage.

And What Happens When Sling Surgery Is A Success

Debbie is 61-year-old mother of one. Her leaking woes started shortly after giving birth to her daughter 28 years ago. “Being a mom and caretaker, I kept putting myself off,” she explained.

But then, a few years ago, she started trying everything from core exercises to a pessary, but neither stopped the leaking for long. She had reached her threshold. Debbie decided “enough is enough!” and that it was time for a urethral sling surgery .

During the outpatient surgery, a sling is placed around the urethra to lift it back into a normal position and create a hammock to keep you from leaking. Studies show that about 8 out of 10 women might be cured after the surgery. Some may still have some leakage because other problems are causing incontinence. Over time, some women say that the leakage can come back. To increase the chances of a successful surgery, doctors recommend quitting smoking and doing pelvic floor exercises.

It can take anywhere from 2 to 6 weeks to recover fully from the surgery. Dr. Ferrante advises that women don’t lift heavy objects or participate in strenuous activities . If there’s difficulty peeing, the sling may need to be readjusted or removed.

After years of leakage stress, Debbie could finally laugh without worry.

Have you considered getting a sling surgery, or have an experience with the surgery already? Share your story with us in the comments.

Is A Bladder Sling The Same As Mesh

A transvaginal mesh procedure is entirely different from bladder sling surgery. While both may use synthetic mesh, transvaginal mesh is a high-risk surgery intended for pelvic organ prolapse. Production of mesh for this surgery was banned by the FDA in 2019, while bladder sling surgery remains a safe and viable option for SUI.

Read Also: What Causes Weak Bladder In Females

Vaginal Extrusion And Erosion

One of the main concerns with bladder slings has been mesh extrusion or erosion. Extrusion and erosion both refer to mesh forcing its way into the vagina, bladder, urethra or other organ. In these cases, the mesh wears through the tissues.

According to a paper by Dr. Cristiano Mendes Gomes and colleagues, vaginal extrusion rates vary from 0 percent to 1.5 percent for retropubic slings, which are inserted through an incision in the vagina and positioned in a U shape around the urethra. The ends of retropubic slings are maneuvered between the bladder and pubic bone and brought out through incisions above the pubic bone.

For transobturator slings, the vaginal extrusion rates vary from 0 percent to 10.9 percent, according to the paper published in Internal Brazilian Journal of Urology. Known as TOT, this procedure avoids the space between the pubic bone and the bladder. Mesh is inserted through the vagina and the ends are brought out through incisions between the labia and the creases of the thighs.

Additionally, Gomes and colleagues found urethral erosion happened after less than 1 percent of sling surgeries.

Three months postoperatively, she stated that her husband felt teeth in her vagina during sexual intercourse, Siegel wrote.

A pelvic exam revealed mesh extrusion.

In some cases, conservative management of erosion may be possible. For example, some surgeons may prescribe topical estrogen cream to help vaginal tissues heal.

So Are There Any Risks For Synthetic Slings

Absolutely. In fact, in addition to the risks that are typical of almost any incontinence surgery, the synthetic mid-urethral slings have risks that are unique to them. The important point is not that there are no risks, there are. Rather, it is that mid-urethral slings offer a good balance between risk and effectiveness. The most common side effect of synthetic sling surgery is urinary frequency and urgency that begins after surgery. Possible causes of this can include irritation from the surgery or compression of the urethra by the sling. Irritation from the surgery will often improve over the first few weeks after surgery compression of the urethra will not. It can be difficult to even know if urinary frequency or urgency is associated with surgery if a patient already had these symptoms before. This is one of the many reasons it can be helpful to have a diary of voiding and incontinence before ever proceeding with treatment.

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How Painful Is Bladder Sling Surgery

The actual procedure should be painless, since it will involve anesthesia. During bladder sling surgery recovery, you may feel pain at the incision site, as well as some internal abdominal cramping. Your physician should prescribe you with pain medication during those first few days or weeks, but if your pain is unmanageable, see your doctor right away.

What Are The Concerns About Vaginal Mesh

Types of surgical mesh, including polypropylene, have been used since the 1950s for various medical uses including abdominal surgery. Use in vaginal prolapse surgery came later and in 2002, the first polypropylene mesh device was cleared by the FDA for use in repair of vaginal prolapse. But between 2002 and 2011, the FDA noted that higher numbers of surgical complications were seen with mesh products used to treat vaginal prolapse through a vaginal incision than had been expected. Some of the discrepancy may have been because these devices were initially compared to slings for stress incontinence, which have lower rates of serious complications. By 2011, the FDA requested more information about the safety of these prolapse devices and began to warn the public that vaginal mesh to treat prolapse may carry higher risks than previously thought. In 2016, the FDA went further and changed the classification of the devices from a moderate-risk category to a high-risk category and required manufacturers to conduct new studies designed to assess whether the devices were safe for use. It should be noted that the FDA explicitly stated at that time that these orders did not apply to synthetic slings used to treat stress incontinence.

Also Check: What Is A Sling For The Bladder

What Is A Bladder Lift

A bladder lift involves cutting into the abdomen and lifting the neck of the bladder to return it to its typical position. This procedure corrects sagging in the urethra and bladder, so youre less likely to leak urine.

When a surgeon stitches the neck of the bladder in this lifted position to secure it to nearby structures, the procedure is referred to as colposuspension.

The surgeon may also place a midurethral sling under the urethra during the surgery. The sling acts like a hammock to support the urethra and the bladder and provide increased bladder outlet resistance.

There are two types of slings:

• Artificial sling: involves a small strap made of mesh
• Traditional sling: uses a small piece of tissue taken from your own abdomen or thigh

Bladder lift surgery typically has a high success rate, and the effects can last for several years. However, urine leakage may come back over time.

A 2019 review of studies found that overall cure rates were as high as 88 percent for colposuspension following surgery.

However, cure rate declined steadily to about 70 percent of people by 10 years after surgery. The cure rate appears to reach a plateau at 65 to 70 percent of patients at a 20-year followup.

Sling surgery is a newer procedure that seems to have similar or slightly better effectiveness as colposuspension, according to a 2021 study. More research is need on longterm performance, though.

What Is A Male Bladder Sling

A male bladder sling or male urethral sling is a surgical treatment for incontinence in men. It is common in stress incontinence but can improve the symptoms of other types.

After placing a male bladder sling, no manual skill or training is required. It works mechanically as a hammock that brings up the urethra and applies gentle pressure. Since it works by itself and does not have complex mechanical parts, patients usually have rapid results .

There are two male bladder sling options available at the moment. One of them is Boston Scientifics AdVance Male Sling System, and the other is Coloplasts Virtue sling. The former uses two arms to do the job, and the latter uses four arms. In the past, there was also a three-arm sling available, the Argus sling.

Also Check: What Does Overactive Bladder Feel Like

Urine Culture And Urinalysis

One of the contraindications listed above is a urinary tract infection. Thus, it is imperative to perform a urinalysis and urine culture. Patients should take the sample after cleaning their penis, especially the glans. They should take a sample after urinating a small amount and make sure that the cup is sterile. If they are not circumcised, they should retract the foreskin before taking the sample. If a urinary infection is detected, it should be treated before the male sling procedure.

How Long Do You Need A Catheter After Bladder Surgery

After the operation

This is a large bag of fluid that flushes out the bladder and drains out through the catheter. Sometimes the catheter must stay in place for a while after you go home. The blood in your urine will slowly clear and then the catheter can come out. This is normally about 1 to 3 days after surgery.

• Inflammation.

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What Will Happen During Surgery

• You may be given general anesthesia to keep you asleep and free from pain during surgery. You may instead be given anesthesia to numb the surgery area. With this anesthesia, you may still feel pressure or pushing during surgery, but you should not feel any pain. A small incision will be made in your vagina to insert the sling. You may also have small incisions in your lower abdomen or thigh.
• The sling will be placed under your urethra and around the area where your urethra and bladder meet. One end of the sling will be on each side of your urethra. The ends of the sling may be stitched to your abdominal wall. Small pins or screws may instead be placed in your pelvic bone to hold the sling in place. Your healthcare provider will check for correct placement of the sling. Any small incisions will be closed with stitches or medical glue. A bandage with antibiotic medicine may be put inside your vagina to help prevent infection.

Different Types And Placements Of Midurethral Slings

If you and your healthcare provider determine that a midurethral sling is your best option to treat your stress urinary incontinence, some other decisions must be made. There are two main types of midurethral synthetic procedures: retropubic and transobturator. The retropubic technique is the first procedure introduced to treat stress incontinence and is commonly referred to as TVT . Transobturator was developed to minimize the potential for bladder injuries and is considered the safer of the two options to perform because unlike TVT, it avoids surgical movements between the pubic bone and the bladder. TOT and TVT are both types of slings made of polypropylene mesh, which stays in place without sutures and allows scar tissue to grow around and through it.

Cure rates for TVT range from 65-95% after 11 years. Long-range data for TOT is unavailable, but its short-term effectiveness has found to be similarly effective. Use of the mesh midurethral sling is supported by the American Urogynecologic Society and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction.

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How Long Will I Bleed After Bladder Sling Surgery

VAGINAL BLEEDING AND DISCHARGE: Initially you may have slight vaginal bleeding, which is usually followed by a dark brown discharge this may last up to four to six weeks after vaginal surgery. The bleeding should not be heavier than a normal period. Use sanitary pads only, tampons are not permitted.

Whats The Process For Getting A Sling Placed

Placing a mid-urethral sling is a minor surgical procedure. The Womans Center urogynecologists are highly experienced in placing these slings. They let you know what to expect before, during, and after your procedure. Generally, they use a general anesthetic during the surgery.

Most patients are able to go home the same day their mid-urethral sling is placed. The Womans Center monitors you closely after your surgery.

Once any postoperative pain is effectively managed and you can empty your bladder normally, they release you to recover comfortably at home.

Within a few days, youll be able to drive and go about your normal daily routine. In two weeks, you can generally resume sports and any other physically strenuous activity.

You dont have to live with leakage. To learn more about mid-urethral slings and to find out if one is right for you, call The Womans Center or schedule your appointment online.

Also Check: I Have A Weak Bladder Help

Risks Of Having Treatment For Cystocele

Most people who have cystocele repair surgery dont have problems after their surgery. Rarely, the following complications can happen:

• Urine leakage
• Painful sex
• Wearing away of the material on the sling, if you had one placed
• Injury to your bladder or ureters
• Long-term or permanent problems urinating. To help with this, you may:
• Have to insert a catheter into your bladder to drain your urine.
• Need another surgery to correct the problem.

How Painful Is Bladder Lift Surgery

Bladder lift surgery is often done laparoscopically.

This means that a surgeon will make just a few small cuts in the abdomen during the surgery. To perform the surgery, theyll use a small camera and tools inserted through tubes placed in the cuts.

Laparoscopic procedures are less invasive than open surgery. Recovery time for midurethral sling surgery and colposuspension performed laparoscopically is often much quicker than for open surgery.

Youll most likely leave the hospital after your surgery to recover at home. In some cases, though, you may need to stay overnight.

On the other hand, a traditional sling surgery and colposuspension with abdominal surgery usually require that you stay in the hospital to recover for a few days.

You may feel some pain or cramping in your lower abdomen and may need to take pain medications for 1 or 2 weeks. Most people fully recover from this procedure in about 6 weeks.

As with any surgery, bladder lift surgery comes with some risks. These include:

• bleeding

Read Also: Can You Have A Bladder Infection Without Symptoms

Management Of Incontinence Surgery Complications

06 September 2010

Sling surgery has replaced Burch colposuspension as the most common surgery for women with stress urinary incontinence . While incontinence surgery has become a routine part of urologic care, the management of surgical complications and recurrent incontinence can be quite difficult.

Sling surgery has replaced Burch colposuspension as the most common surgery for women with stress urinary incontinence . While incontinence surgery has become a routine part of urologic care, the management of surgical complications and recurrent incontinence can be quite difficult.

It is important that the urologic surgeon is well informed about the most common complications that are associated with sling surgery, and how to best manage them. In addition, the management of recurrent incontinence following sling surgery should follow a stepwise approach, with appropriate diagnostic studies, conservative treatment if possible, and surgery if necessary. While sling surgery in the patient with urethral hypermobility is often straightforward, reoperation for recurrent incontinence can be more technically challenging.

Clinical presentation can vary from no symptoms to vaginal bleeding, discharge, discomfort, pain, dispareunia or hi-pareunia.

When bladder or urethral erosion occurs the tape can be removed endoscopically, with an open approach or combining the two. It is recommended not to place another sling at the same time.

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Counting The Cost Of Sling Surgery

In addition to health risks, sling surgery is a costly option for leaky bladders. The price tag can range from $6,000 to $25,000. And even after surgery, women still spend on average $190 a year to manage residual leaks, spending money on pads, laundry, and dry cleaning. For those women who need a second surgery to remedy a bad first outcome, the total cost can quickly rise to $50,000 for surgical removal of a failed implant.

On the flip side, electing not to pursue any treatment is expensive, as well. The same study referenced above found that women spend on average $750 per year managing their incontinence symptoms.

Also Check: How Long Should A Bladder Infection Last

What Symptoms May Mean You Need A Bladder Lift

Bladder lifts are intended for people who have moderate to severe stress incontinence that doesnt get better with conservative treatments like pelvic floor physical therapy and behavioral therapy.

The main symptom of stress incontinence is leaking urine during certain types of physical activities that put pressure on the bladder. These include:

• laughing
• having sexual intercourse

Urinary leakage may be the result of a weak sphincter muscle, which controls urine flow.

It may also be due to changes in the angle of the urethra. The urethra is the tube that carries urine from the bladder to the outside of your body.

Stress incontinence may also occur as you get older because these muscles tend to weaken as you age. It can also be caused by damage to the nerves of the bladder or the nervous system due to health conditions such as:

• diabetes
• multiple sclerosis
• a stroke

People assigned female at birth are more likely to suffer from stress incontinence than people assigned male at birth. This is due to the structure of their bodies.

During pregnancy, stress incontinence can be caused by a growing uterus pressing on the bladder. Following childbirth, it may be caused by changes to the pelvic floor.

A radical prostatectomy, or surgery to remove the entire prostate gland for prostate cancer, is a common cause of stress incontinence for people with male anatomy.