Reviewed by: Brindusa Vanta
Bladder sling surgery is a common procedure to relieve stress incontinence, also known as urinary incontinence. This condition is characterized by an involuntary urinary release when you sneeze, exercise, or put pressure on the bladder. It's also used to treat pelvic organ prolapse. When lifestyle modifications and pelvic floor therapy don't provide enough relief, bladder slings are the next line of treatment. Whether you're scheduled for bladder sling surgery or just looking to learn more about them, this blog will guide you through the ins and outs of this procedure.
What Are Bladder Slings?
Bladder slings are surgical procedures that are designed to treat stress urinary incontinence. Bladder slings also help manage pelvic organ prolapse, when pelvic organs herniate through the vaginal opening. Slings are thin, narrow straps made from synthetic materials like mesh or your own tissue.
Purpose of Bladder Slings
Bladder slings are designed to support the urethra and bladder neck, which are the muscles responsible for controlling the release of urine. Supporting these muscles reduces the risk of leaks or accidents. Think of a bladder sling as a hammock that physically lifts and supports the urethra.
Types of Bladder Slings
There are different types of bladder slings that each serve their own purpose and have unique benefits and risks.
Transvaginal Slings
Transvaginal slings are the most commonly used type of bladder slings. They are typically made of synthetic mesh materials inserted through the vagina. This sling is placed under the urethra to lift and support it. One advantage of transvaginal slings is that they are less invasive than other slings, and the recovery period is relatively short. However, there is a risk of mesh erosion or infection, which may require additional surgery.
Suprapubic Slings
Suprapubic slings, also known as abdominal slings, are inserted through an incision in the abdomen. The sling is then secured to the pubic bone to support the bladder and urethra. Subrapubic slings have a lower risk of mesh erosion than transvaginal slings. However, they also have a more extended recovery period, as the placement surgery is more invasive.
Mini-Slings
Mini-slings are a newer type of bladder sling that is gaining popularity. They are similar to transvaginal slings in insertion and placement but are smaller in size and use fewer incisions. The smaller size and less invasive nature of mini-slings make them a good option for patients who are not good candidates for transvaginal or suprapubic slings. However, they are a newer technology, and long-term data on their efficacy is still emerging. One study did find that mini-slings had similar success ratings after 36 months as suprapubic slings.
Indications for Bladder Slings
It's always best to consult a medical professional to determine if you need a procedure, but there are some signs that show it may be a good idea.
Urinary Incontinence
Urinary incontinence, or loss of bladder control, is a leaking of urine that happens by accident. People with urinary incontinence may feel a strong and sudden urge to urinate that prevents them from getting to the toilet in time. Incontinence can also occur when the bladder muscles are stressed, such as coughing, sneezing, laughing, or exercising. Urinary incontinence can range from occasional leaks to frequent accidents. Persistent urinary continence is common during pregnancy, after childbirth, and as women go through menopause. Neurological disorders, including multiple sclerosis, a stroke, or spinal injury, can also cause incontinence.
Pelvic Organ Prolapse
Pelvic organ prolapse (POP) is a kind of pelvic floor disorder. Pelvic organ prolapse occurs when the pelvic organs herniate to or through the vaginal opening. The pelvic organs are supported by a complex "hammock" of muscles, ligaments, and fibers that attach to the pelvis. Weakening these structures through childbirth can result in the descent of the organs. POP can be asymptomatic, where nothing extends beyond the vaginal opening, or symptomatic when there is protruding tissue. Although not life-threatening, POP can profoundly impact women's quality of life, and many women are hesitant to seek treatment out of embarrassment or shame.
The Procedure for Bladder Slings
As with most medical procedures, there is a lengthy process involved in getting a bladder sling.
Preparation for Surgery
In preparation for surgery, your doctor may tell you to stop taking medicines that can make it difficult for your blood to clot. These include aspirin, ibuprofen, and warfarin. Be sure to ask your doctor which medications are safe before surgery. On the day of your bladder sling surgery, you likely won't be able to eat or drink anything for up to 12 hours before you arrive at the hospital.
Description of the Surgical Process
This type of surgery is usually performed under anesthesia. Next, the surgeon will make a small incision in the vagina or abdomen, depending on the type of sling. Abdominal and transvaginal slings are stitched to the abdominal wall, while mini-slings are held in place and suspended by pelvic tissue. After surgery, you'll likely remain in the hospital overnight or for a few days before being discharged.
Postoperative Care
After undergoing bladder sling surgery, following specific postoperative care instructions is essential to ensure proper healing and a smooth recovery. Immediately following the surgery, you may experience discomfort, pain, and swelling in the area. You'll be prescribed pain medication to take for relief. Spotting and vaginal discharge are normal. The stitches placed during surgery will dissolve over the next several weeks. Be sure and attend all follow-up appointments so your doctor can monitor your healing process.
It's also important to avoid strenuous physical activity for at least six weeks after the surgery to prevent damage, infections, or other complications. This includes going to the gym, lifting more than 20 pounds, and most forms of housework. Most patients can return to work within two weeks. Sexual intercourse should be avoided for 6 to 12 weeks.
While not all patients require a catheter after surgery, it's sometimes necessary. The nurses at the hospital will teach you how to use the catheter before you're discharged from the hospital.
Length of Recovery Time
Recovery time after bladder sling placement surgery can vary depending on the individual and the extent of the surgery. Patients who had a traditional sling procedure usually require an overnight stay in the hospital to monitor their recovery and ensure stability. After being discharged, patients can typically resume light activity within a few days, but avoiding any strenuous activity or heavy lifting for at least six weeks is recommended to allow the surgical site to heal properly. Most patients can return to work and their usual daily activities within two to four weeks after surgery, although this can vary depending on the individual and their job requirements.
How Long Does the Bladder Sling Last?
According to clinical studies, bladder slings have an overall good safety profile and are an effective surgical treatment for stress urinary incontinence. However, the longevity of bladder slings can vary depending on the individual and the type of sling used. It's also important to note that bladder sling placement does not guarantee permanent relief of urinary incontinence, and some patients may require additional treatments or procedures over time.
Risks and Complications of Bladder Slings
As with any surgical operation, bladder sling placement has its risks. While uncommon, bladder sling surgery can result in complications that include:
- Injuries to nearby organs
- Mesh erosion
- Damage to the urethra and bladder
- Difficulty urinating
- Urinary retention
- Development of overactive bladder
- Urinary tract infection
- Wound infection
- Difficult or painful sex
- Groin pain
- Worsening urine leakage
Before undergoing bladder sling surgery, you must weigh the pros, cons, and potential risks with your doctor. If your incontinence is mild, it may not be worth risking possible surgical complications.
Success Rates and Outcomes of Bladder Slings
According to Mayo Clinic, bladder sling surgery has an 85-95% success rate. Mesh complications, such as erosion or infection, are only reported in 3% of cases. Factors such as age, health, and BMI can affect long-term outcomes. One study found that women with higher age and BMI had less successful long-term results after five years than younger women.
Alternatives to Bladder slings
Bladder slings are the right solution for some women, but they may not be suitable for you. If that's the case, then there are numerous alternatives for you to try. Pelvic floor exercises, including Kegels, can help strengthen your bladder muscles and reduce the risk of leaks. Avoiding irritating foods such as acidic fruits, spicy foods, and caffeinated beverages can also help. Your doctor can prescribe medications and topical estrogen creams. Medical devices such as Pessary, a flexible silicone ring inserted into the vagina, support the urethra to prevent urine leakage. Be sure to talk to your doctor to determine which treatment is right for you.
Absorbent incontinence products are also a great option for extra protection at home and on the go. Nexwear offers advanced and tech-tested leak protection, absorption, and odor control to help keep you confident and secure. So whether you choose protective underwear or bladder pads, you can enjoy worry-free no-fail protection with any of our products.