Introduction
Sub urethral slings are a common surgical procedure for stress urinary incontinence. Slings used in women are either made of mesh or made from the body owns tissue (rectus fascia). The decision to place a sub urethral is made after careful consideration of the risks and benefits of the procedure and is performed when non-surgical treatments do not work, or the incontinence is severe and disrupts a patient’s quality of life.
Indications
The sub urethral sling is used to treat stress urinary incontinence that has not responded to non-surgical treatments.
Preoperative Instructions
All patients are given full instructions on how to prepare for the procedure well ahead of the day of surgery. In most cases the following preparation is required:
- Inform the surgical team of what medications you are currently taking and follow any guidelines given by the team, especially regarding blood thinning medication.
- If any symptoms of illness occur before the procedure (e.g. cold or fever) inform the surgical team.
Procedure
The technique for placing a suburethral sling differs depending upon the type of sling used – mesh vs native tissue (rectus fascia). In both procedures, an incision is made in the vaginal to create the space where the sling will be placed. With a native tissue sling, an additional incision in made in the abdomen and a piece of tissue covering the abdominal muscles is excised and used to create the sling. The sling, either mesh or native tissue is then placed under the urethra like a hammock though the vaginal incision. A cystoscopy is then performed to ensure that no component of the sling has perforated the bladder. Once this is done, the wounds are then closed, and the procedure is completed.
Postoperative Instructions
The length of hospital stay and the post-operative recovery depends upon the type of sling used – mesh or native tissue. The placement of a mesh mid urethral sling is usually performed as a day procedure or overnight stay. The patient is discharged home once they are passing urine well and is followed up in the clinic at 6 weeks’ time and then periodically thereafter. The placement of a native tissue sling requires the patient to remain in hospital for up to three days as there is slightly more discomfort from the abdominal incision and there is often a tube called a drain left in the abdomen which is often removed after 48 hours. The native tissue sling has a greater risk of difficulty urinating after it has been placed, therefore these patients are seen earlier in the clinic in about 2 weeks. All patients are advised to not do any heavy lifting or straining for 6 weeks after the procedure.
Risks
The risks following the placed of a sub urethral sling are:
- Bleeding.
- Infection.
- Retention of urine.
- Bladder perforation.
- Mesh erosion or exposure (mesh slings).
- Hernia (native tissue sling).
- Seroma (collection of fluid underneath the abdominal wound – native tissue sling).
Treatment Alternatives
The treatment alternatives to suburethral slings for stress urinary incontinence including continence pessaries, urethral bulking agents and colposuspension (an operation on the vaginal to help support the urethra and reduce the risk of leakage.)