What Are Mid-Urethral Slings?
Mid-urethral slings are a strip of surgical tape or mesh placed underneath the urethra to treat stress urinary incontinence (SUI) in women. If you have questions about a procedure you’ve had done or are experiencing symptoms of urinary incontinence, please speak with one of our experienced staff members.
The History of Urinary Incontinence
Urinary incontinence, any uncontrolled leakage of urine, is a common medical problem that affects millions of women worldwide. In countries that have access to modern medical care, this is an easily treatable condition. However, in undeveloped countries, it is a cause of significant misery and social stigmatization. Women are often shunned and treated as outcasts due to the problems urinary incontinence can cause with personal hygiene and odor.
Surgeries to correct urinary incontinence have existed for more than 70 years. Prosthetic devices (pessaries) that are inserted into the birth canal to improve bladder neck support have also been used as treatment for decades. Early surgeries to correct/treat stress urinary incontinence proved to have poor long-term success rates as up to 50% of women reported having a recurrence of their symptoms. This led to efforts to develop more reliable procedures. Over the years, a variety of surgeries that improved the long-term success rates of SUI treatment were designed. However, these procedures were often quite difficult to perform and tended to be associated with long recovery times.
Since the mid-2000’s, mid-urethral sling surgery has
become the preferred treatment for correction of
uncomplicated stress urinary incontinence in women.
In the mid-1990’s, a gynecologist in Switzerland developed and introduced the first surgically placed mid-urethral sling which he named TVT, or Tension-free Vaginal Tape. It was dually advantageous for both surgeons and patients as it led to high long-term success rates and was much simpler to place, resulting in less post-op pain and faster recovery. In the early 2000’s, mid-urethral sling surgery was approved by the United States Food and Drug Association (FDA) and was quickly adopted by American surgeons. By the mid-2000’s, mid-urethral sling surgery had become the preferred treatment for correction of uncomplicated stress urinary incontinence in women. The American Urogynecologic Society and the Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction both endorse mid-urethral slings as first line treatment for stress urinary incontinence. These procedures are considered to be the Standard of Care, meaning, mid-urethral slings should be the first choice for surgical correction of stress incontinence unless there are other factors involved.
The Technique and Recovery of Mid-Urethral Sling Surgery
Mid-urethral sling surgery consists of making a small incision in the vaginal skin underneath the mid-urethra. A pathway or tunnel is created around the urethra on either side and a strip of tape or mesh is slipped into place.
There are three variations of mid-urethral slings. Depending on the type of mid-urethral sling surgery, small incisions may be made behind the pubic bone or on the inner thigh to help position the sling most effectively.
Cystoscopy (looking into the bladder with a small camera) is performed at the end of surgery to ensure that the urinary tract has not been injured.
The surgery can usually be performed in under an hour and patients will typically be able to go home the same day. Because urinary retention can occasionally occur, it is required that patients empty their bladder before being discharged. Most patients are able to return to work one week after surgery. While the incisions are healing, patients are advised to avoid excessive straining, strenuous exercise, heavy lifting, and intercourse.
Complications during and following mid-urethral sling surgery are uncommon, but in rare cases, the bladder or urethra can be injured during surgery. The area around the bladder neck has a generous blood supply and bleeding is an occasional problem, as is injury to blood vessels or nerves. With any surgery, complications from anesthesia or infection in the procedure area is possible.
Due to the nature of the surgery, urinary retention or a sense of urgency may occur, although these symptoms are usually temporary.
Misinformation about the mesh used to make mid-urethral slings is widely circulated, but they are safe and reliable with a low risk of causing problems later on. Rarely, they can erode through the vaginal skin and cause pain or into the bladder or bladder neck. If this occurs, surgery may be required to remove the mesh.
Mid-urethral slings are a reliable and permanent treatment for stress urinary incontinence. These procedures are easier to perform with shorter recovery times and fewer complications than other treatments. If you are suffering from urinary incontinence, Associates in Women’s Health is ready to help.