Urethral Suspension—Sling Procedure Overview

Stress incontinence is one of the many causes of uncontrolled leaking of urine. Urethral suspension is a surgery to correct incontinence in women.

The incontinence is most often caused by weakening of the pelvic muscles that normally keep the bladder in position. The muscles may be weakened by:

• Pregnancy
• Childbirth
• Menopause
• Previous pelvic surgery
• Lack of physical activity

Female Bladder and Urethra © 2009 Nucleus Medical Media, Inc.

Prior to Procedure

Your doctor will try to find out why you are leaking urine through some or all of the following:

• Medical history—information about medicines, illnesses, number of pregnancies, and previous surgeries; pattern of leaking and how it is affecting your life
• Urine sample—to look for the presence of infection or other problems
• Physical exam —includes a rectal and vaginal exam
• Additional testing may be ordered to evaluate bladder function and urine flow, such as:

• Urodynamic testing (urine flow studies)—a temporary catheter is placed to study bladder function
• Cystoscopy —a procedure done to view the inside of the bladder

Leading up to surgery:

• Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

• Aspirin or other anti-inflammatory drugs
• Blood thinners, such as warfarin (Coumadin)
• Clopidogrel (Plavix)
• Arrange for a ride home from the hospital.
• Do not eat or drink anything after midnight the night before.

Anesthesia

You may receive a spinal anesthetic to numb your lower body. General anesthesia may also be used, in which case you will be asleep.

Description of Procedure

This procedure will require one or two small incisions in the abdominal wall and vagina. The incisions will be made just above the pubic bone. A sling will be placed under the urethra. The sling will close the urethra when pushed down by a sneeze, cough, or other stressors. This will prevent incontinence. The sling can be made out of a synthetic material or tissue from your own body.

Immediately After Procedure

After surgery, you will be monitored in a recovery room. You will most likely have a catheter in place to drain your urine.

How Long Will It Take?

1-1½ hours

How Much Will It Hurt?

Anesthesia will block pain during the surgery. After surgery, you may experience some pain or soreness. You will be given pain medicine to relieve the discomfort.

Average Hospital Stay

You may be sent home the same day.

Postoperative Care

At the Hospital

At first, your urine may look bloody. This will resolve over time. When you are able to empty your bladder completely, the catheter will be removed. You may be up and walking on the same day as the surgery.

At Home

Avoid lifting and strenuous exercise for six weeks after surgery. This will allow healing to take place.

To help ensure a smooth recovery, follow your doctor's instructions .

RESOURCES:

National Kidney and Urologic Diseases Clearinghouse
http://kidney.niddk.nih.gov/

Urology Health.org
http://www.urologyhealth.org/

CANADIAN RESOURCES:

The Canadian Continence Foundation
http://www.continence-fdn.ca/

Canadian Urological Association
http://www.cua.org/

References:

Surgeries for female stress incontinence. US National Library of Medicine, Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/print/ency/article/002992.htm . Updated May 2008. Accessed October 20, 2009.

The surgical management of female stress urinary incontinence. The American Urological Association website. Available at: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/fsuimainrpt.pdf . Published 1997. Accessed October 20, 2009.

Surgical management of urinary incontinence. American Urological Association website. Available at: http://www.urologyhealth.org/adult/index.cfm?cat=03&topic=133 . Updated 2003. Accessed October 20, 2009.

Surgical mesh. US Food and Drug Administration website. Available at: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm142636.htm . Updated October 8, 2009. Accessed October 20, 2009.

Surgical treatment for female stress urinary incontinence. National Association for Continence website. Available at: http://www.nafc.org/bladder-bowel-health/types-of-incontinence/stress-incontinence/surgical-treatment-for-female-stress-urinary-incontinence/ . Updated July 2009. Accessed October 20, 2009.

Treatment and prevention. The American Urogynecologic Society website. Available at: http://www.mypelvichealth.org/TreatmentPrevention/BladderControlProblems/TreatmentOptions/Surgery/tabid/120/Default.aspx . Accessed October 20, 2009.

Townsend MK, Danforth KN, Rosner B, Curhan GC, Resnick NM, Grodstein F. Physical activity and incident urinary incontinence in middle-aged women. J Urol. 2008;179:1012-1016; discussion 1016-1017.

Wein AJ. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2007: chap 67.