Urinary incontinence - vaginal sling procedures

Definition

Vaginal sling procedures help control stress incontinence, urine leakage that can happen when you laugh, cough, sneeze, lift things, or exercise. They help close your urethra (the tube that carries urine from the bladder to the outside) and the bladder neck (the part of the bladder that connects to the urethra).

See also:

• Artificial sphincter surgery - urinary
• Urinary incontinence - collagen implants
• Urinary incontinence - retropubic suspension
• Urinary incontinence - tension-free vaginal tape

Alternative Names

Pubo-vaginal sling; Transobdurator sling

Description

Vaginal sling procedures use either tissue from your body, tissue from someone else's body, or synthetic (man-made) material.

The doctor will make 1 small incision (cut) in your vagina and another small incision just above your pubic hair or in the creases of your thighs. Most of the operation is done through the cut in your vagina.

The doctor creates a sling from the body tissue or synthetic material. The sling passes under your urethra bladder neck. The doctor attaches the sling to tissues in your lower belly that are very strong.

Why the Procedure Is Performed

Vaginal sling procedures are done to treat stress incontinence.

Most of the time, your doctor will try drugs and bladder retraining before talking about surgery with you. If you have tried those things and you are still having problems with urine leakage, surgery may be your best option.

Risks

Risks for any surgery are:

• Incision infection or the incision opens up
• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Bleeding
• Other infection

Risks for this surgery are:

• Damage to the urethra, bladder, or vagina
• It may become harder to empty your bladder. You may need to use a catheter.
• Breaking down of synthetic material used for the sling
• Urine leakage may get worse.
• Irritable bladder, where you may feel the need to urinate more often
• Fistula (or connection) between the vagina and the skin
• Changes in the vagina (prolapsed vagina)

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, 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 drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of the surgery.
• You may be asked to shave your pubic area before the operation.
• If you smoke, try to stop. Your doctor or nurse can help.

On the day of the surgery:

• You will usually be asked not to drink or eat anything for 6 to 12 hours before the surgery.
• Take the drugs 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.

After the Procedure

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

You may be in the hospital for less than 24 hours. Some people need to stay for 1 or 2 days.

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.

References

Oh S-J, Stoffel JT, McGuire EJ. Pubovaginal sling. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders; 2007:chap 67.