Midurethral Slings

Your physician has recommended that you undergo a surgical procedure to correct stress incontinence.  Stress incontinence is leakage of urine that occurs with any increase in intra-abdominal pressure.  Coughing, laughing, sneezing, and exercise are common causes of stress-related leakage.  Current theories place the cause of stress incontinence at the level of the urethra, or the tube through which you urinate.  Research has suggested that incompetence at the level of the mid and/or proximal urethra leads to leakage of urine.  Vaginal sling procedures are designed to correct the incompetent urethra.

Midurethral Sling Surgery

The choice of which sling to use depends on your particular clinical situation.  With all slings you will undergo day surgery for the sling unless you are undergoing other surgical procedures (prolapse repair, hysterectomy, etc.).  The type of anesthesia used will be determined by the patient and the anesthesiologist.  Most of these procedures could conceivably be performed under local anesthesia with sedation.  Most often women choose to undergo general anesthesia.  Operative time for these slings range from 5-20 minutes.  Dissolvable sutures are used to close the vaginal wall.  If incisions are created in the groin or suprapubic area, skin glue will be used to close the incisions.

Post-operative Course
After approximately one hour in the recovery room, the patient will be sent to the day surgery unit.  A few patients may have undergone additional surgery that may require a hospital stay.  If only a transobturator sling is performed, no catheter will be placed in the  urethra therefore the patient will need to void prior to discharge.  Approximately 85% of the patients will be able to void spontaneously.  If the patient is unable to void, a catheter will be placed and removed the following day in our office.  Those patients that undergo  “combination” surgery will have the catheter removed after 1-2 days in the hospital.  Patients will usually note pain in the groin area but not in the vagina.  This usually will require the use of pain medications for several days.  This should not prevent normal movement around the house.  Usually, the patient can return to desk-type duties at work within one week (or sooner if the patient feels able).  If the patient is not having pain and is not on pain medication, driving is not restricted.  Vigorous physical activity is restricted for 4 weeks.  Walking up to 3.5 mph on the treadmill or walking briskly in the neighborhood is the maximum aerobic activity reasonable in the post-operative period.  Lifting is restricted to 10 pounds or less.  Intercourse is restricted for 4 weeks.  After the 4 week period, there are no further restrictions on activity.

Post-operative Visits
Patients will be seen in the office two weeks after surgery.  This visit includes a urinalysis and a symptom check.  Residual urine will be checked with a non-invasive bladder scanner. Assuming that the patient is doing well, she will be seen in the office approximately 3 months later.  The patient will be examined during this visit to be sure there are no problems with healing in the vaginal wall or groin.  If all is well, the patient will be discharged at that time.  If there are any further difficulties post-operatively, additional visits may be necessary.