Urethral Sling

What is a Sling?

A sling is a strip of mesh which restores the support to the urethra and bladder neck.  Women who have lost this support can leak urine when they cough, laugh, sneeze, or bear down, because it is difficult for the bladder outlet to stay closed when it suddenly moves. When it is forced open slightly, urine leaks out. The sling is a surgical procedure where an incision is made in the vaginal wall and the sling is then positioned between the vagina and urethra. The strip of mesh is passed behind the pubic bone in either a U shaped or V shaped fashion to sit like a hammock so that when you bear down, it limits the movement of the bladder outlet. Slings are extremely effective for treating stress incontinence and becoming completely dry.

Is it Vaginal Mesh?

Yes. It is a strip of mesh which is placed through a vaginal incision. However, a sling is mesh for incontinence, not pelvic organ prolapse. After review of numerous studies, the FDA determined that mesh for prolapse repairs carried an unacceptably high risk profile, and these types of mesh were pulled from the market. Slings, on the other hand, have not been found to pose any greater risk for adverse events than any other type of common surgery involving a graft material.

Due to the excellent efficacy of slings, they have remained the gold standard surgical option for stress incontinence. In women who do not want mesh, a sling can be made from your own tissue, but this requires a separate lower abdominal incision, similar to a c-section. When you come for a consult, Dr. Kumar will be happy to discuss these issues with you in more detail.

What can I expect during and after procedure?

A sling is a surgical procedure, performed in a sterile operating room under anesthesia.  The surgery takes about 30-45 minutes once you are under anesthesia. You go home the same day, and Dr. Kumar will make sure you are able to urinate before you leave. You will have sutures in the vagina which take 4-6 weeks to dissolve. You will be instructed to continue light activity, such as walking and you can drive and go up a flight of stairs. You should avoid heavy lifting (more than 20lbs), straining, or vigorous exercise for about 3-4 weeks. You may have slight discomfort in the suprapubic or thigh/groin area, which subsides within a couple of days.