Urinary incontinence - vaginal sling procedures

Description

Vaginal sling procedures use different materials:

• Tissue from your body
• Tissue from the body of a person who has died (cadaver tissue)
• Tissue from a pig or cow
• Manmade (synthetic) material

You have either general anesthesia or spinal anesthesia before the surgery starts.

• With general anesthesia, you are asleep and feel no pain.
• With spinal anesthesia, you are awake but from the waist down you are numb and feel no pain.

A catheter (tube) is placed in your bladder to drain urine from your bladder.

The doctor makes one small surgical cut (incision) inside your vagina. Another small cut is made just above the pubic hair line or in the groin. Most of the procedure is done through the cut inside the vagina.

The doctor creates a sling from the tissue or synthetic material. The sling is passed under your urethra bladder neck and is attached to the strong tissues in your lower belly.

Why the Procedure is Performed

Vaginal sling procedures are done to treat stress urinary incontinence.

Before discussing surgery, your doctor will have you try bladder retraining, Kegel exercises, medicines, or other options. If you tried these and are still having problems with urine leakage, surgery may be your best option.

Risks

Risks of any surgery are:

• Bleeding
• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection in the surgical cut or the cut opens up
• Other infection

Risks of this surgery are:

• Breaking down of the synthetic material used for the sling
• Erosion of the synthetic material through your normal tissue
• Changes in the vagina (prolapsed vagina)
• Damage to the urethra, bladder, or vagina
• Fistula (abnormal passage) between the vagina and the skin
• Irritable bladder, causing the need to urinate more often
• It may become harder to empty your bladder, and you may need to use a catheter
• Urine leakage may get worse

Before the Procedure

Tell your doctor or nurse what medicines you are taking. These include medicines, supplements, or herbs you bought without a prescription.

During the days before the surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other medicines that make it hard for your blood to clot.
• Ask your doctor which medicines you should still take on the day of the surgery.
• If you smoke, try to stop. Your doctor or nurse can help.

On the day of the surgery:

• You will likely be asked not to drink or eat anything for 6 - 12 hours before the surgery.
• Take the medicines your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital. Be sure to arrive on time.

After the Procedure

You may have gauze packing in the vagina after surgery to help stop bleeding. It is usually removed a few hours after surgery.

You may leave the hospital on the same day as surgery. Or you may stay for 1 or 2 days.

The stitches (sutures) in your vagina will dissolve after several weeks. After 1 - 3 months, you should be able to have sexual intercourse without any problems.

Follow instructions about how to care for yourself after you go home. Keep all follow-up appointments.

Outlook (Prognosis)

Urinary leakage gets better for most women. But you may still have some leakage. This may be because other problems are causing urinary incontinence. Over time, the leakage may come back.

Alternative Names

Pubo-vaginal sling; Transobdurator sling

References

Appell RA, Dmochowski RR, Blaivas JM, Gormley EA, et al. Female Stress Urinary Incontinence Update Panel of the American Urological Association Education and Research. Update of AUA guideline on the surgical managementof female stress urinary incontinence. J Urol. 2010;183:1906-1914.

Dmochowski RR, Padmanabhan P, Scarpero HM. Slings: autologous, biologic, synthetic, and midurethral. In: Wein AJ, Kavoussi LR, Novick AC, et al., eds. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 73.

Wai CY. Surgical treatment for stress and urge urinary incontinence. Obstet Gynecol Clin North Am. 2009;36:509-519.

Update Date: 12/12/2012

Updated by: Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.