A vaginal sling procedure, also called a pubovaginal sling, is a type of surgery that helps women who have urinary incontinence.
Urinary incontinence is the medical term for an inability to control the bladder—a problem that leads to urine leakage. For some people, the leakage occurs after coughing or sneezing. Others with this condition may have strong, sudden urges and leakage before they can make it to the toilet. When this problem becomes so severe that it affects daily life, your doctor may recommend a vaginal sling procedure to correct or help with this problem.
When you urinate, a circular-shaped muscle around your bladder relaxes and releases urine into a tube called the urethra. During a vaginal sling procedure, the doctor will use a piece of tissue (either synthetic or from your body) to make a sling around the urethra to help keep it closed.
Urinary incontinence can be corrected with a variety of treatments, depending on how severe the condition is. If you have leakage that doesn’t stop even after trying other treatments, your doctor may recommend surgery, or the vaginal sling procedure. Your doctor may also recommend this procedure if you have a very severe case and your bladder problem disrupts your everyday life.
There are three main types of vaginal sling procedures:
Conventional slings are created by using a synthetic material, your tissue, animal tissue, or tissue from a deceased person’s body. This tissue or material is then inserted around the urethra and fastened with stitches.
Tension-Free Slings (or Tension-Free Vaginal Tape)
During this procedure, the physician places a material, usually made of mesh, around the urethra like a sling. Instead of using stitches to keep it in place, the tension-free sling is held in place by the surrounding tissue.
This is a kind of sling that can be adjusted during and after surgery. One benefit of this is that it can be done while you are awake. This particular procedure is currently being studied by researchers. It is not known how effective it is compared to the other sling types.
Any time you undergo surgery or have an opening made in the skin, there are basic risks involved. These risks include bleeding, blood clots, breathing problems, and infection.
There are also some specific risks if you have a vaginal sling procedure, including:
- changes in the vagina (dropping or prolapsed vagina)
- fistulas (an abnormal growth or tunnel that forms between the skin and the vagina)
- injury to structures around the area (bladder, urethra, vagina)
- irritation around the bladder
- overactive bladder or problems emptying the bladder
Over time, the material used to create the sling can break down and create complications. If you are elderly and have atrophic vaginitis, this surgery may not be recommended.
Before the procedure, be sure to tell the surgeon about any medications you are taking, especially if you are on a blood thinner. Your surgeon may have you stop taking it a few days or hours before the surgery. You may also need to stop taking other medications that thin the blood, such as aspirin and ibuprofen.
Because surgery often involves anesthesia, you will probably have to abstain from eating or drinking anything for six to 12 hours before the surgery.
Be sure to dress in comfortable clothes and arrange a ride home.
A vaginal sling procedure is considered surgery. Before the surgery begins, you will undergo either general anesthesia or spinal anesthesia to prevent pain during the surgery. You will also likely have a catheter, or tube, inserted into your bladder in order to drain urine.
During the surgery, the surgeon will make a small incision, or cut, inside the vagina and another small incision around the pubic hair line. The surgeon will take the strip of tissue or synthetic material through the incision and secure it around your urethra, either with or without stitches, depending on the type of sling.
Although it depends on your health history, this operation is usually performed on an outpatient basis. In some cases, you will need to stay in the hospital for one to two nights to recover. In most cases, you can fully recover from this procedure within one to three months. You will probably have a few follow-up appointments with your doctor. Be sure to keep these, and follow any discharge and care instructions that you are given after surgery.