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 about 80-90% effective for treating stress incontinence.
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. It has been difficult for patients to understand the difference when the mesh for prolapse and incontinence is all grouped together as, “vaginal mesh.”
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. You will need to be cleared by your medical doctor prior to the procedure, and it is imperative you are not taking any blood thinners for at least one week prior. The surgery takes about 30-45 minutes once you are under anesthesia. After the surgery, you may feel some soreness above the pubic bone and you will have stiches in the vagina. You go home the same day, and Dr. Kumar will make sure you are able to urinate before you leave. About 10% of patients will need to go home with a urinary catheter. You will be instructed to avoid heavy lifting, straining, or anything in the vagina until the wound fully heals.
What are the risks?
The risks of any surgical procedure are bleeding, infection, and injury to surrounding structures. When you have a sling, Dr. Kumar will check intraoperatively to make sure there is no injury to your bladder. After the surgery, some women have difficulty urinating and will require a catheter. In the postoperative period, about 10-15% of women experience new onset overactive bladder or incomplete bladder emptying. At the time of your 6 week follow up appointment, Dr. Kumar will check a vaginal exam to make sure the wound has healed. A small percentage of women will develop an extrusion of the mesh from the vaginal incision after the surgery and this can be removed. In rare cases, patients can have pain for longer than the normal postoperative period. If this happens, Dr. Kumar will discuss revising or removing the sling.