Sling Treatments for Stress Incontinence

Sling treatments for stress incontinence at a glance

• Doctors can utilize a sling treatment, which is a hammock-like device made of tissue from the patient’s own body or synthetic mesh, to support the urethra to stop urine leaking during activity.
• Sling procedures are the most common treatment for stress incontinence.
• There are several types of sling surgical procedures, including midurethral and traditional slings and all have high success rates coupled with a low risk of side effects or complications.

What causes stress incontinence?

The cause of stress incontinence is the weakening of muscle and other tissues that support the bladder and the muscles that regulate the release of urine. Stress incontinence affects up to 1 in 3 women. It can also affect men but is much more common in women. The most common cause of stress incontinence is brought on by childbirth, and one-third of all postpartum women develop symptoms.

Stress incontinence is a type of urinary incontinence, the unintentional loss of urine. Stress incontinence happens when physical movement or activity puts pressure on the bladder causing it to leak. These activities could be sneezing, coughing, heavy lifting or exercising.

Common causes of stress incontinence that can be treated by a sling include:

• Mothers of multiple children and women who gave birth vaginally are at greater risk for stress incontinence than mothers with only one child or when delivery was through surgical means.
• Women highly active in athletic activities requiring long distance running or extended periods of small, sharp impacts, such as running on hard surfaces, jumping repeatedly on a hard surface or heavy weight lifting.
• Aging, menopause or estrogen deficiencies in women, which can thin the urethra and weaken the pelvic floor.
• Injury caused by radiation in cancer treatment.

How sling treatments prevent stress incontinence

Sling procedures use tissue from the patient’s own body or synthetic mesh to create a “sling” or “hammock” to provide support to the urethra. This helps keep the urethra stay closed and prevents leakage of urine.

The sling can also be made from donor tissue or animal tissue. However, CU Urogynecology does not use animal tissue slings. Most sling procedures rely on synthetic material or tissue from the patient, due to the human body’s predisposition to absorb donor and animal material, which can create problems.

Slings vs. Mesh: What You Need to Know

Types of sling procedures for stress incontinence

The type of sling procedure best for a woman is assessed by a qualified urogynecologist after careful examination of a patient’s medical history. Some types of sling treatment are better suited for patients than others due to prior existing medical conditions, previous surgical history or severity of incontinence.

The average rest period following surgery differs from patient to patient and by type of procedure. However, most patients are back to normal activity within two to eight weeks. The biggest restriction after surgery is a lifting limit of five pounds. A good benchmark is that a gallon of milk weighs eight pounds, so it is over the weight restriction.

Kinds of sling procedures we offer to treat stress incontinence include the following.

Midurethral sling or tension-free sling

A midurethral sling, also known as a tension-free vaginal tape (TVT) sling, is a small mesh strip used to treat stress urinary incontinence. The sling is made of a polypropylene mesh, which is suture material woven together. Once the sling is in position, over the next 3 to 4 weeks the woman’s tissues will grow and anchor it in position.

The sling prevents leakage by supporting the urethra and mimicking the ligaments that have been weakened by having a child or the aging process. There are three main placements for the sling during surgery: retropubic, transobturator and the single incision sling, or minisling.

• Retropubic. This is the most common sling procedure performed at CU Urogynecology because it has been used for many years and is highly effective. The retropubic sling is most commonly used on women with severe stress incontinence. During this procedure a small incision is made in the vaginal wall over the midpoint of the urethra. The surgeon will place the sling between the cut, passing it on either side of the urethra and exiting through two small incisions made above the pubic bone. The sling placement is then corrected to sit loosely underneath the urethra, and the vaginal cut is stitched to cover the sling.
• Transobturator. The transobturator approach also requires a small incision made in the vagina at the same location as the retropubic sling. A transobturator sling’s ends go through two small incisions in the groin. Once placement is confirmed, the skin is closed over them and stitched into place. We use this procedure less often because it is not as effective at treating severe stress incontinence.
• Minisling. The minisling, or single incision sling, is the newest surgery option. It is similar to a retropubic approach except the ends of the sling do not come out onto the skin and are anchored in position by a number of techniques. Long-term this option has not been shown to be effective and is typically not used by our practice.

If performed on its own, the sling procedure is typically a 30-minute walk-in procedure. If the surgery is done in combination with a prolapse surgery, the patient may be admitted for an overnight hospital stay.

After surgery most patients are able to empty their bladder efficiently, however some may go home with a catheter if there is swelling. In these cases, the woman will then come back 1-2 days later, when the swelling around the urethra has gone down, to have the catheter removed. A woman should be able to drive and participate in usual daily activities a week after surgery.

We advise to avoid heavy lifting and sports for 6 weeks to allow the wounds to heal and the sling to be firmly held in place. We also advise the patient abstain from sexual activity for 8 weeks after the operation.

Traditional sling

The traditional, or conventional, sling approach frequently requires a larger incision than a midurethral sling. Through this incision the surgeon will pull the sling to the optimal tension and attach each end of the sling to the pelvic tissue or abdominal wall using stitches.

A traditional sling is also called an autologous fascial sling. An autologous fascial sling is made from the fascia connective tissue in the abdomen. This tissue is harvested before the procedure from the patient.

A patient undergoing a traditional sling procedure may need to stay overnight in the hospital, because of the required abdominal incision, and usually has a longer recovery period than with a midurethral sling. Some patients with a traditional sling also need a temporary catheter while healing is completed.

Risks of all sling surgeries

There is no completely risk-free surgery for stress incontinence. Complications for any sling treatment include urinary tract infections, bleeding, difficulty urinating, sling exposure, bladder or urethral perforation, urge incontinence, pain and infection.