Urethral Slings: What Are The Risks, Benefits and Recovery?
Mid-urethral slings have become the most common method to treat stress urinary incontinence (SUI). They are typically placed in under 30 minutes in an outpatient setting and are popular with both physician and patients due to the high cure rate, relative ease of placement, low complication rate and quick recovery.
The prototype of modern day slings is the TVT (tension-free vaginal tape), and many similar ones exist on the market that are placed in a similar fashion, but ultimately perform the same function. TVT has been around for approximately 15 years and is used worldwide.
The sling is made of a thin strip of polypropylene mesh weave, a common and safe type of mesh used for surgery in a variety of body locations. The width is 1 cm and the length left in the body is usually between 6-8 inches long. There are various methods for placing slings, but ultimately, it must rest under the mid-urethra.
It is placed through a small incision in the vagina, usually under general anesthesia, and women can go home the same day without a urinary catheter after urinating in recovery. Vaginal stitches to close the skin dissolve, but the sling is permanent. It becomes incorporated into the body tissue. The body lays new collagen and scar within the sling and around it, and it becomes a new firm ligament under the urethra replacing the one that had become weak. The sling acts like a backboard and supports the urethra during straining maneuvers such as coughing, sneezing, laughing, jumping and exercise. It prevents it from descending, thereby preventing urine loss.
Slings are durable to about 10-15 years but longer term data does not exist simply because it hasn’t been around that long. It is less invasive than the next most popular procedure for SUI, the Burch colposuspension, which requires a bikini line abdominal incision and then the bladder neck is raised up and stitched close to the back part of the pubic bone. Despite equivalent cure rates, surgery time and recovery time is longer. It has generally fallen out of favor as a modern approach to curing SUI.
We value and respect the experiences of all of our HERWriters, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice although we hope you can gain knowledge from their insight.
Add a Comment34 Comments
Dr. Karlovsky, you neglected to mention any of the risks associated with the procedure. These issues are seldom mentiond by surgeons, but can't be ignored by someone looking to manage this quality of life problem. See:
http://www.fda.gov/cdrh/safety/102008-surgicalmesh.html
March 13, 2009 - 4:48amThis Comment
8-7-09
August 7, 2009 - 6:11amThanks for your comment. I am well aware of the FDA warning, as most pelvic surgeons ALREADY know about the risks of mesh and implantation on the body. I was glad actually to see the FDA come out with the warning due to industry pressure to push product use on physicians who are not trained formally to use such mesh products or who have limited knowledge of amatomy or complication management. See my other blog entries on mesh risks on this site. NO SURGERY is without risks, but what you fail to appreciate is two things: 1. This procedure should be performed by a surgeon who is skilled and not on the "learning curve". 2. TVT-type sling surgery for fixing urinary incontinence is the gold standard and the most successful and durable treatment of ALL treatments (surgical and non-surgical). -Matthew Karlovsky, M.D.
Very helpful information. Why didn't my doc tell me most of this before or even after my surgery? Having been on many other sites it seems as though many woman are left with questions afterward; in particular regarding bleeding and soreness. I know that I sort of "rushed" into it just wanting to end my incontinence issue without asking questions, but I also feel that he should have addressed these things as I didn't know to ask them. After the surgery I was on the phone 2 or 3 times asking questions that are answered here. I'm going to suggest my doctor take a look at your site and perhaps create a "handout" of sorts that explains what to (typically) expect from this seemingly simple procedure. Thanks again for your clear, concise and helpful information.
December 18, 2009 - 7:41pmThis product currently carries an FDA warning because of the reported negative side effects!!!
January 11, 2010 - 12:40pmI am a female who is almost 28 yrs of age and tested positive for UI, I am thinking about having a urethral sling put in, just want to know what I should be expecting afterwards
March 10, 2010 - 2:01pmi have just had the sling placed 2 weeks ago. i have quality of life now after 10 years of not talking about the problem casue of embarrassment. i was in and out in one day. no stiches, and the only 2 opens were in pubic area between my two legs. they used a glue instead of stiches. i was great the next day and after 3 days i didn't even feel like i had surgery. the doctor told my husband that i would feel like i could do anything and he was right. the only thing is you can't pick up anything heavier than 10lbs or have sex for 6 weeks. i don't wear pads at all and i feel empowered. free yourself
August 16, 2010 - 9:47amHi Anon - Thank you for writing and welcome to EmpowHER. The following links will provide you with more information about the urethral sling procedure.
http://www.empowher.com/media/reference/urethral-suspension
http://www.empowher.com/media/video/which-surgical-procedure-used-treat-...
http://www.empowher.com/news/herarticle/2009/04/08/youre-injecting-what-...
I hope this addresses your concerns, will you let us know?
March 10, 2010 - 6:05pmTake care, Pat
Thank you Pat, I am finding your provided links very benificial.
November 28, 2011 - 1:33amI had a BioArc sling placed when I had my hysterectomy in December of 2006. Two years ago, I started having pain in my left lower abdomen, but no one could figure out what was causing it. Six weeks ago, we did. The left side of the mesh sling is now protruding into my vagina and I will have surgery this week to have it removed. NOT ONCE did the doctor who placed this (GYN) tell me that this was a possibility or even suggest that I should have this checked out. Now my family practitioner is convinced that the "phantom" pain was probably this! I had to go to a regional teaching hospital (OHSU) and consult with a urogynocologist who will do the surgery to remove this. The local urologist I consulted first said to put a little estogen cream on it and perhaps that would solve the problem! When I asked him how many of these he had seen and removed he became irritated with me and said "one or two." Then he told me to learn to live with a little pain! With a huge amount of these procedures resulting in injury (some cutting through to the baldder) from the slings coming out, this procedure should be approached with a great deal more caution than what I was led to believe would be the magic bullet for solving my UI issues.
August 16, 2010 - 11:14amAnon - It both saddens and angers me to read about your experience. I'm glad you finally have the answers you need and are getting the specialized care you deserve. Women have been told to "live with" too many things for far too long. I'm glad you wrote in, and I hope you will continue to share what you learn with us and help other women. Best wishes for a solid and safe procedure at OHSU.
August 16, 2010 - 5:17pmTake care,
Pat