A mid-urethral synthetic sling is used to treat stress urinary incontinence (SUI) in women. SUI is when sudden pressure on the bladder and urethra causes the sphincter muscles to open briefly and leak urine. Patients with mild SUI could experience leakage from sudden forceful activities, such as laughing, sneezing, exercising, or coughing. Severe SUI could cause leaks from less forceful activities such as walking, standing up, or bending over.
Causes of SUI
Stretching, weakening, or damage of the pelvic floor could lead to SUI. Other causes can include pregnancy, childbirth, chronic coughing, pelvic surgery, or nerve injuries to the lower back.
Risk Factors for Stress Urinary Incontinence
The risk of SUI is higher due to:
- Smoking
- Being overweight
- Pregnancy
- Childbirth
- Being female
- Chronic coughing
- Pelvic or prostate surgery
- Nerve injuries to the lower back
Diagnosing SUI
To determine whether a patient has SUI, the physician will begin by asking about symptoms. The patient will need to describe their symptoms, how they’ve been affected, and how often they experience incontinence. The physician will also need to know which prescription drugs, vitamins/herbs, and over-the-counter medicine the patient is taking.
Next, the physician will ask questions about previous surgeries and illnesses, past and present health, diet, fluid intake, menopausal status, and childbirth history.
During the physical exam, the physician will check the patient’s abdomen, the organs in their pelvis, and their rectum. For men, the physician will check their genitalia, abdomen, prostate, and rectum.
Testing may include a urinary pad test, urinalysis, bladder scan, cystoscopy, and urodynamic studies. Depending on the results, patients may be treated with a mid-urethral synthetic sling.
What is a Mid-Urethral Sling?
To implant a mid-urethral sling, the surgeon will make a small incision in the vagina and two small skin incisions in the groin area. Next, the surgeon uses specially designed needles to position a thin piece of synthetic mesh under the urethra. The ends of the mesh will be pulled through the skin incisions and adjusted for tension. Over time, the tissue grows through the weave of the mesh to secure the sling.
The two types of mid-urethral slings are transobturator sling and retropubic sling. The transobturator sling is placed like a “smile” around the pelvis, whereas the retropubic sling is placed like a “U.”
The patient will be placed under intravenous sedation or general anesthesia. Surgery takes less than 30 minutes and patients can go home once they’re able to empty their bladder and the pain is controlled. Patients who aren’t able to empty their bladder immediately may temporarily use a catheter.
The Recovery Process
Women will need three to 10 days to recover from synthetic sling surgery. It’s normal to feel tired while the incisions are healing. Patients should avoid heavy lifting and strenuous activities for six weeks after surgery to give their wounds time to heal and ensure the sling stays in place.