Sling surgery is the most common surgery doctors use to treat urinary stress incontinence. That’s when certain movements or actions, like coughing, sneezing, or lifting, put pressure on your bladder and make you pee a little.
The surgeon creates a “sling” out of mesh or human tissue. Then they put it under the tube that urine passes through, called the urethra. The sling is like a hammock that lifts and supports your urethra and the neck of your bladder (where your bladder connects to your urethra) to help prevent leaks.
Lifestyle changes like losing weight and doing Kegel exercises or pelvic floor therapy may help if you have a mild case of urinary stress incontinence. But if you’ve tried those and still have symptoms that affect your quality of life, sling surgery might be an option.
In most cases, it lessens or stops urine leaks.
How It’s Done
More women have stress urinary incontinence than men. With women, doctors use two types of sling surgery:
Mid-urethral sling surgery is the most common. A thin strip of mesh is used to make the sling, and your surgeon will put it under your urethra in one of three ways. Each type takes about 30 minutes.
- Retropubic method (also called the tension-free vaginal tape, or TVT, method): Your surgeon will make a small cut inside your vagina, under your urethra. They’ll also make two tiny cuts above your pubic bone, just big enough to fit a needle through. They’ll then use a needle to put the sling under your urethra and behind your pubic bone. Skin glue or stitches that get absorbed by your body will be used to close the cuts.
- Transobturator method: Your surgeon will make the same small cuts inside your vagina, under your urethra, but they’ll put one on each side of your labia (the folds of skin on either side of your vagina). The sling is then put under your urethra.
- Single-incision mini method: Your surgeon will make one small cut in your vagina and put the sling through it.
No stitches are used to attach the sling. Over time, scar tissue forms around it to keep it in place.
Traditional sling surgery is similar to the mid-urethral surgery. Your surgeon will take a strip of tissue from your stomach or thigh to make the sling, or they might use tissue from a donor. Then they’ll make two cuts, one in your vagina and one in your belly. They’ll stretch the sling through the cut in your stomach, then stitch it to the inside of your stomach wall.
Men and Sling Surgery
Men also can have sling surgery. The surgeon will make a small cut between the scrotum and anus and put the sling around part of the urethral bulb (the enlarged end of the urethra in men).
This will squeeze and lift the urethra, which helps prevent leaks.
After the Surgery
Mid-urethral surgery is an outpatient procedure, which means you usually go home the same day. You may need a catheter after surgery until you heal. That’s a thin, flexible tube that helps drain pee from your body when you can’t use the bathroom on your own.
After sling surgery, you might feel pain for a few days or weeks. You shouldn’t strain, exercise hard, or lift anything heavy until your doctor says it’s OK.
For women, your doctor will also recommend vaginal rest x 4-6 weeks after surgery. this is similar to post partum vaginal rest.
Things to Consider
Some of the side effects of sling surgery include:
- Having a hard time peeing or, in rare cases, not being able to pee
- Having to pee too often
- Urinary tract infections
- Painful sex
If mesh is used, there’s a very small chance that it could start to break down in your vagina. This happens in only about 2% of people who have sling surgery with mesh. Most of the time, this can be treated with a vaginal cream or by cutting the exposed piece of mesh. In a few cases, doctors recommend surgery to remove part or all of it.