A synthetic midurethral sling is a narrow mesh strip made of monofilament polypropylene used to treat stress urinary incontinence. The sling is inserted through the vagina beneath the mid-urethra and exits at two points in either the suprapubic or groin areas. This treatment is considered when conservative methods such as pelvic floor exercises and behavioral changes have not been effective.
What is Stress Urinary Incontinence?
Stress urinary incontinence happens when physical activities or movements, like sneezing, coughing, running, laughing, bending over, having sex, or lifting heavy objects, exert pressure on the bladder, leading to urine leakage. This condition is not caused by psychological stress.
Stress urinary incontinence can result from weakened muscles and tissues that support the urethra and regulate urine release. In a normal urinary system, the bladder expands as it fills with urine, while the urethra (a short tube that carries urine out of the body) remains closed to prevent leakage. The urinary sphincter also plays a role in controlling urine release.
In women, the pelvic floor muscles and urinary sphincter can weaken due to:
- Childbirth
- Aging
- Obesity
- Previous pelvic surgeries
- Long-term high-impact activities like running and jumping
- Smoking, which leads to frequent coughing
- Illnesses causing chronic coughing
If left untreated, this condition can cause mixed urinary incontinence, emotional distress, and skin rashes or irritation.
Benefits of a Synthetic Midurethral Sling
Recent advancements in synthetic slings offer several benefits:
- Durable
- Minimally invasive
- Outpatient procedure
- Reduction in urinary symptoms post-surgery, such as urinary retention, urgency, frequency, and urge incontinence
- Quick recovery
Types of Midurethral Slings
There are three main types of midurethral sling insertion techniques: retropubic, transobturator and single-incision slings.
Retropubic Sling: This sling is placed behind the pubic bone, close to other organs. This method carries a slightly higher risk compared to the transobturator approach, and patients may have difficulty emptying their bladder post-surgery.
Transobturator Sling: This sling is inserted through the groin, avoiding interference with other organs, making it safer. However, patients might experience pain, including during intercourse. The choice of sling depends on the hospital’s available slings and the surgeon’s experience.
Single-incision sling: This is also called a mini-sling. There are small anchors that secures the mesh in place. There is only one vaginal incision.
What to Expect During Surgery
During the surgery, the patient will receive local, spinal, or general anesthesia to block nerve function and pain. The surgical steps include:
1. Emptying the bladder.
2. Inserting a catheter to ensure the bladder is completely empty.
3. Making a small incision in the front of the vaginal wall to insert the sling.
4. Positioning both ends of the sling on either side of the urethra, forming a hammock shape.
5. Performing a cystoscopy to visualize the bladder and check for any injury caused by the sling placement.
Potential Risks and Side Effects
The risks of surgery is very low. However, midurethral sling surgery may result in adverse reactions, including urinary tract infections, and injuries to the bladder, blood vessels, urethra, or bowel. Patients may also experience voiding dysfunction, pain, vaginal mesh exposure, and mesh perforation or extrusion.
Choose UCI Pelvic Health Center
If you’re experiencing stress urinary incontinence, contact UCI Pelvic Health Center today for treatment. Our expert team offers synthetic midurethral sling surgery, ensuring a minimally invasive procedure with quick recovery.