The mid-urethral sling is the most common treatment for stress urinary incontinence.
A sling (hammock-like material) is placed underneath the urethra through a small vaginal incision. Sling materials include the patient’s own tissue (an autologous rectus fascial sling), donor tissue (from an animal or a cadaver), or most commonly a synthetic material (mesh).
When to ask a Urologist about Mid-Urethral Sling
You should speak with a Urologist about Mid-Urethral Sling if you are bothered by stress incontinence (urine leakage with coughing, laughing, sneezing, or other physical activity).
Cost
Typically covered by most insurances (although coinsurance and deductibles may apply). Coverage will be verified prior to proceeding. If you do not have insurance, our office will be able to give you an out-of-pocket cost estimate.
Effectiveness
Mid-urethral sling has a high level of patient satisfaction and about 85% success rate of eliminating stress incontinence at one year.
Possible Side Effects
Possible risks following mid-urethral sling placement include bleeding, infection, damage to surrounding structures, ongoing urinary incontinence, urinary retention, pelvic pain, leg pain, painful intercourse, and mesh erosion. Mesh erosion occurs in about 2% of cases at one year and may require treatment with local hormone cream or subsequent procedures. Women with a history of diabetes or smoking are at greater risk for mesh erosion.
Alternative Approaches
Alternatives to mid-urethral sling placement may include observation without treatment, vaginal devices such as pessaries, or urethral bulking injections.
What to do to Prepare for Surgery
You will receive detailed instructions from the surgical schedulers regarding any necessary testing or appointments prior to surgery. In general, you should temporarily stop blood-thinning medications prior to surgery (when to stop depends on the type of blood thinner). Prescription blood-thinning medications should be stopped following clearance from the doctors that prescribed them though other medications that thin the blood including fish oil and pain relievers such as ibuprofen should be stopped as well.
On the day before surgery, you will receive a phone call alerting you to the time that you should arrive, and you should wash the surgical area with an antibacterial soap.
You should not eat or drink anything after midnight on the day of surgery, but you may take approved home medications in the morning before surgery with a small sip of water.
What to Expect after Surgery
The procedure is performed under anesthesia either as an outpatient or with a possible overnight hospitalization. A urinary catheter is typically left in place for a few hours along with a vaginal packing. After a few hours, the catheter and packing are both removed. Patients must urinate prior to discharge, and a catheter may need to be temporarily replaced for several days if there is difficulty emptying the bladder.