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Urinary incontinence - vaginal sling procedures
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).
Pubo-vaginal sling; Transobdurator sling
Vaginal sling procedures use:
- Tissue from your body
- Tissue from someone else's body
- Man-made (synthetic) material
The doctor will make one small surgical cut in your vagina and another small cut just above your pubic hair or in the creases of your thighs. Most of the procedure 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 for any surgery are:
- 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 for this surgery are:
- Breaking down of the synthetic material used for the sling
- Changes in the vagina (prolapsed vagina)
- Damage to the urethra, bladder, or vagina
- Fistula (connection) between the vagina and the skin
- Irritable bladder, where you may feel 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
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.
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.
Oh S-J, Stoffel JT, McGuire EJ. Pubovaginal sling. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders; 2007:chap 67.
Wai CY. Surgical treatment for stress and urge urinary incontinence. Obstet Gynecol Clin North Am. 2009;36:509-519.
Dmochowski RR, Blaivas JM, Gormley EA, et al. Female Stress Urinary Incontinence Update Panel of the American Urological Association Education and Research, Inc, Whetter LE. Update of AUA guideline on the surgical management of female stress urinary incontinence. J Urol. 2010;183:1906-1914.
Reviewed By: Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.