The Urethral Sling

Take control and restore your lifestyle! YOUR LIFESTYLE

Loss of bladder control is treatable!

Talking about Stress Urinary Incontinence.

Millions of women, of all ages, suffer from stress urinary incontinence (SUI).
It is an epidemic among postmenopausal women. 

Stress urinary incontinence is embarrassing and socially demoralizing, causing some people to severely limit their activities and lifestyles.

Urine leakage is more common as we have babies and age but it is never considered "normal". There is no need to accept it and just "live with it" by using pads and changing the way you want to live.

Many treatment options for SUI are available now. And they are available to women of all ages, no matter how long you have lived with the problem.

The first step is talking about it!

Causes of Stress Urinary Incontinence (SUI):

Stress urinary incontinence is a condition that results in accidental loss of urine when coughing, laughing, sneezing or simply from getting up from a chair. SUI can be caused by any single condition or a combination of conditions. To effectively diagnose and treat urinary incontinence, a doctor must determine the cause.

Pregnancy and Childbirth: Weakened or stretched pelvic muscles and tissue can be the result of pregnancy and childbirth, causing the bladder and urrthra to relax from their normal position. The bladder and urethra must be well supported by the pelvic muscles and tissues to allow them to work properly.

Aging and Genetic Factors: Loss of collagen and elasticity of the pelvic muscles happens with age and is accelerated after menopause. Certain genetic conditions may also affect tissue strength and tone.

Medical Conditions and Surgery: Certain medical and neurological conditions such as spinal cord injury or arthritic changes with aging, Multiple Sclerosis, Parkinson's Disease, Stroke and Diabetes can make incontinence worse. Post surgical changes after a hysterectomy or pelvic surgery will often change the anatomy and make a patient more prone to leakage.

Urinary Tract Infections: Urinary tract infections can cause temporary incontinence, and certain medications may cause leakage as well.

Obesity: While obesity does not cause incontinence, it does contribute to the condition due to the increased abdominal pressure.

Smoking: While not a direct cause of incontinence, smoking may aggravate urinary incontinence. 

What is a Sling and how does it work?

The Urethral Sling is a minimally invasive procedure performed to correct stress urinary incontinence. It utilizes the concept of providing support for the urethra and helps correct the anatomical changes so that continence can be restored. This procedure has been shown to improve SUI in 80 to 90% cases. The sling material used is made of polypropylene, which is an inert material that is very well tolerated by the body.

This procedure is to treat stress urinary incontinence. The urethral sling is not a cure for urgency although it may help with this symptom. 

What is involved? 

The Urethral Sling is performed under a light anesthetic, and takes about 15 minutes. The primary incision is made just inside the vagina under the urethra and is less than an inch long. Two tiny incisions are made in the inner groin. The sling is tunnelled between these incisions inside the body passing through the obturator foramen of the pubic bone. The incisions are then either closed with dissolvable sutures or surgical glue. 

What to Expect after a Sling? 

Initial studies have shown it to cure SUI in 92.9-94.1% of cases in the short term (follow up of up to 5 years). Improving pelvic muscle tone by doing pelvic muscle exercises (Kegel exercises) and continuing to do them after surgery will ensure that the operation is a success.

Many women present initially with a degree of frequency and urgency along with their SUI.The support of the urethra with the sling can often improve or resolve this overactivity.

You will be able to see results very quickly, even as soon as the same day of the procedure. But remember, the placement of the sling involves some manipulation of the urethra and surrounding tissues so you will see the most dramatic improvement at the three month mark after the majority of healing is complete.

A small amount of bleeding is expected immediately afterwards. This will resolve after the first few days. Antibiotics are always given during the procedure and prescribed to be taken for 5 days afterward to prevent infection. Anesthesia relaxes the urinary tract so in extremely rare cases a women may develop difficulty urinating following surgery. This almost always resolves overnight and may require the use of a catheter until the next morning. A slight burning or stinging of the urethra or tissues is also to be expected but will disappear quickly, Keeping the urine dilute by drinking plenty of water or other nonacidic fluids afterwards will help. 

The anesthesia department at the Surgical Center at Coral Springs is exceptional. They will make every effort to ensure that every patient is as comfortable as possible throughout the procedure. Patients are prepared specially to prevent nausea afterwards which makes the experience so much more pleasant. Anesthesia is never without some risk, but during a sling procedure the anesthetic used is light and for such a short time, that chances are as minimal as possible.

Healing is quick after a sling and pain is typically minimal. Taking an anti-inflammatory for one week afterwards will help with both, although I do give a stronger analgesic to take if necessary.

Limitations afterwards:

Please, nothing in the vagina for a full 6 weeks!

No heavy lifting over 5 lbs and no strenuous workouts.

No sitting on a bike seat, power walking or running for 6 weeks.

Once everything is healed and the sling has collagen ingrowth you are safe to do everything you did before and even better without leaking!

Follow Up after a Urethral Sling:

A follow up appointment is made for two weeks post procedure although we are available anytime by phone or by earlier visit if there are any questions or concerns.

The suture in the vagina is dissolvable so no suture removal is necessary. You may notice a discharge from the vagina one to two weeks after which is the suture material dissolving away. Any roughness in the vagina is the suture that may be felt for weeks, but this will resolve and the sling should not be palpable or recognizable by a partner. It will be discretely healed under the vaginal wall.

In the inner groin there will be skin glue that is used to close a tiny incision, too small for a regular suture. It will fall off within a week, but please do not remove it before it comes off naturally. This will allow the area to heal quickly.