Slings can provide extra support to keep urine from leaking when sneezing, laughing, or coughing.
The process of urination is controlled by muscle contractions of the bladder. These contractions are, in turn, controlled by spinal nerves. If something causes bladder muscles and related nerves not to function properly, the result is uncontrolled urine leakage, referred to as urinary incontinence (UI).
- For some women with stress urinary incontinence, also called an overactive bladder, conservative treatments aren’t effective.
- If this is the case, a urologist may suggest a sling procedure.
Basics of Sling Procedures
The purpose of a sling procedure is to pull up and secure the bladder. Doing so narrows the urethra and minimizes the risk of unexpected leakage from an overactive bladder. “Slings” are pieces of mesh that can be synthetic (manufactured) or created from a patient’s own tissue. Donor tissue may also be used. Slings are used to create a stretchable hammock-like set-up just below the tube where urine travels out of the bladder. Mesh is sometimes placed directly in the spot where the bladder connects to the urethra, referred to as the “bladder neck.”
Synthetic mesh tape is used with a tension-free sling. No stitches are necessary with procedures of this nature. The sling is supported naturally by the body when scar tissue forms in the area where it’s placed. There are three tension-free sling options a urologist may recommend.
- Retropubic sling: An incision is made inside of the vagina by the urethra. Additionally, small openings are made by the pubic bone to allow for the insertion of a needle to place the sling. The openings may be sealed or stitched after the sling is in place.
- Transobturator sling: A transobturator sling procedure involves a smaller incision than what’s used with a retropubic sling. In addition to vaginal incisions, openings are created by the labia for the needle that’s used to place the sling under the urethra.
- Single-incision sling: A single incision is made in the vagina with this procedure. The sling is placed through this small incision.
A conventional sling is done with larger incisions than what’s used with any of the tension-free sling methods. The first incision is made in the vagina to place the sling by the neck of the bladder. A second incision is made through the abdomen so the sling can be pulled to create a sufficient amount of tension. The sling can be attached with stitches to either the abdominal wall or to pelvic tissue.
Normally, it takes approximately 2 to 4 weeks to heal following a sling procedure. It may take longer if larger incisions were made. Strenuous activities and heavy lifting should be avoided during the healing period. Risks associated with slings are considered minimal for most patients.
Stress incontinence, the type of UI that often results in the need for the sling procedures discussed here, is more likely to occur in younger and middle-aged women. Another option other than slings is a surgical implant that can be injected into the space around the tube where urine passes through to create more bulk. A urologist can help a patient determine which treatment will likely minimize or prevent urinary incontinence and improve quality of life based on their specific circumstances.