Urinary Stress Incontinence Sling Procedures

Urinary stress incontinence is the term used to describe involuntary loss of urine due to physical activity or movement. Although the disorder is found in both sexes, women are far more likely to be affected. In situations where more conservative treatment options are ineffective, stress incontinence is sometimes treated through the surgical implantation of a sling-like structure to support the bladder and/or the urethra.

Understanding Sling Procedures

• According to the Mayo Clinic, a sling procedure is designed to allow proper closure of the sphincters that lie at either end of the urethra. In stress incontinence, either these sphincters or the muscles supporting them no longer function properly, resulting in uncontrolled urine flow.

Sling Procedures for Women

• If you are female, there are three basic approaches available for sling implantation. In a conventional sling procedure, your surgeon will make an incision in your vagina and secure a sling made of natural or synthetic material around the neck of your bladder. He will then use a small abdominal incision to pull the ends of the sling into place and surgically attach them to your abdominal wall or pelvic tissue. If you undergo this type of procedure, you will probably need a temporary catheter while your bladder recovers. You may also require an overnight hospital stay after surgery.

  Tension-free slings are synthetic strips of mesh that are implanted without any need for stitches. In this method, your surgeon will place the sling so it is initially supported by your own tissue. Over time, scar tissue that forms as a natural reaction to the mesh will hold it in place permanently. Your surgeon may use one of two methods to implant a tension-free sling. A retropubic placement requires one small incision inside your vagina, and two additional incisions above your pubic bone. Using these openings, your surgeon will thread your sling into place. He will then close the incisions with a special glue. A newer procedure, the transobturator approach, requires only a vaginal incision.

  Your surgeon also might implant an adjustable sling through incisions in your vagina and abdomen. After initially placing the sling, your surgeon will ask you for feedback on its proper positioning. He will then make any necessary adjustments before completing surgery. If your sling requires further adjustment at a later date, a secondary surgery can be performed under local anesthesia. As of 2009, the long-term effectiveness of both tension-free slings and adjustable slings has not been fully studied. Recovery time from sling surgery may extend from two to six weeks.

Sling Procedures for Men

• If you are male, your sling procedure will typically be done as an outpatient surgery. During the procedure, your surgeon will make an incision in the perineum, or space between your scrotum and anus. He will use this opening to place a sling made from surgical tape around the portion of your bladder called the urethral bulb. This placement allows for a minor adjustment in the position of your urethra, which is frequently sufficient to stop or diminish your incontinence. Consult your surgeon for more details.