What is urethral sling surgery?

Urethral sling surgery is done to treat stress incontinence. A sling is placed around the urethra to support it and help it retain urine. Your urethra is the tube that carries urine from the bladder to outside the body.

There are different types of urethral sling surgeries. The two main types of slings are midurethral and traditional. Midurethral slings are made out of synthetic mesh material. Traditional slings are made out of a strip of human or animal tissue.

You may be asleep during surgery. If you are awake, you will get medicine to prevent pain and help you relax.

To do the surgery, the doctor makes small cuts (incisions) in the vagina and lower belly or upper thigh. Then the doctor places a strip of mesh tape or tissue through the incisions and under your urethra like a sling or hammock. Then the incisions are closed with stitches.

You may go home the same day as your surgery. Or you may stay in the hospital overnight. You will probably be able to go back to work in 1 to 2 weeks. But you will need at least 6 weeks to fully recover before returning to all normal activities. You must avoid heavy lifting and strenuous activities during this time.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Avoid strenuous activities, such as jogging or weight lifting, and straddling activities, such as bicycle or horseback riding, for 6 weeks. Or wait until your doctor says it is okay.
• For 6 weeks or until your doctor says it is okay, avoid lifting anything that would make you strain. This may include heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, a vacuum cleaner, or a child.
• Ask your doctor when you can drive again.
• You will probably need to take 1 to 2 weeks off from work. It depends on the type of work you do and how you feel.
• You may shower as usual after 24 hours. Pat the cuts (incisions) dry. Do not take a bath or swim for the first 2 weeks, or until your doctor tells you it is okay.
• Avoid putting anything in your vagina for 6 weeks or until your doctor says it's okay. This can include having sex or using tampons.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Drink plenty of fluids (unless your doctor tells you not to).
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• If you have strips of tape on the incisions, leave the tape on until it falls off.
• Do not wash the area directly, but allow warm, soapy water to run over the incision daily. Then pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
• Keep the area clean and dry.

Exercise

• Ask your doctor when you can do pelvic floor (Kegel) exercises, which tighten and strengthen pelvic muscles. Your doctor may want you to wait several weeks after surgery before you do them.
• To do Kegel exercises:
  • Squeeze your muscles as if you were trying not to pass gas. Or squeeze your muscles as if you were stopping the flow of urine. Your belly, legs, and buttocks shouldn't move.
  • Hold the squeeze for 3 seconds, then relax for 5 to 10 seconds.
  • Start with 3 seconds, then add 1 second each week until you are able to squeeze for 10 seconds.
  • Repeat the exercise 10 times a session. Do 3 to 8 sessions a day.
• If you are having trouble finding out what muscles to squeeze, you can try stopping the flow of urine a few times. But don't make it a practice to do Kegels while urinating.
• If doing these exercises causes pain, stop doing them and talk with your doctor. Sometimes people have pelvic floor muscles that are too tight. In these cases, doing Kegel exercises may cause more problems.
• If you aren't sure how to do these exercises, talk to your doctor about getting a referral to a pelvic floor physical therapist.

Sling surgeries are as effective as other surgeries to cure stress urinary incontinence in women. About 8 out of 10 women are cured after this surgery.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to empty your bowels with an enema or laxative. Your doctor will tell you how to do this.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Some complications of urethral sling surgery include:

• Difficulty urinating after surgery.
• New symptoms of urgency or urge incontinence.
• Injury to an organ (such as the bladder, urethra, or ureters).
• Internal bleeding.
• Infection at the incision site.

All surgeries that use general anesthesia carry a small risk of complications or death.

Usually a few hours after surgery, you will be asked to urinate to test how your bladder and urethra respond to the surgery. If you can't empty your bladder, you may need to have a thin, flexible tube (catheter) placed into your bladder through your urethra. You will have the catheter for a short time. It allows urine to drain while you recover. Or you may be taught to do self-catheterization for a while.

Depending on the surgery, you may be released to go home the same day. Some people have to stay in the hospital overnight. After you are at home, expect a 2- to 6-week recovery period. During this time, you will need to avoid heavy lifting and strenuous activities. Talk to your doctor about when you can return to work.

The amount of pain you have after surgery depends on the exact nature of your procedure, your physical condition at the time of surgery, and your own response to pain. You will probably feel some pain at the incision site and may feel some cramping in your abdomen. Your doctor may prescribe medicine to relieve your discomfort during the first few days after surgery. Be sure to call your doctor if you can't get relief from pain.

Urethral sling surgery is done to treat stress urinary incontinence in women. The sling supports the urethra, which is the tube that carries urine from the bladder to outside the body. After surgery, you may feel weak and tired for several days. Your pubic bone may feel bruised, and you may have some pain or cramping in your lower belly. These symptoms should get better in 1 to 2 weeks. You also may have some vaginal spotting for up to 1 month. This is normal.

You should have less or no urine leakage when you sneeze, cough, laugh, or exercise. In fact, at first you may find that it is harder than usual to empty your bladder. This usually gets better after 1 or 2 weeks.

You will probably be able to go back to work in 1 to 2 weeks. But you will need at least 6 weeks to fully recover before returning to all normal activities. You must avoid heavy lifting and strenuous activities during this time. These might put extra pressure on your bladder while you recover.

The urethral sling procedure may be used for women who have stress incontinence:

• Caused by sagging of the urethra and/or bladder neck.
• Caused by problems with the muscular outlet of the bladder (sphincter).

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The surgery will take about 30 minutes to 1 hour.