Suburethral Sling

The suburethral sling is used to treat urinary stress incontinence or USI. USI is the uncontrollable loss of urine when you cough, sneeze, jump or run. The sling is especially suited to treat a specific type of USI called intrinsic sphincter deficiency or ISD. ISD is a result of an anatomic problem where the urethra comes into the bladder. The urethra is the tube that leads out from the bladder. Normally the urethra is shaped like a tube or pipe. Patients with ISD have a urethra shaped like a funnel.
There are other types of urine loss that are not USI and will not improve if treated with a surgical bladder-neck suspension. One of the types of incontinence that falls into this category includes urge incontinence or UI. UI is loss of urine when you feel the need to urinate but cannot make it to the bathroom. It is possible to have more than one type of urinary incontinence at the same time. If you have both types of urinary incontinence, both urge and stress, you may benefit from surgical repair. But, you must be aware the urge-incontinence component of your problem will not be improved by the surgery and may possibly be made worse.

Factors that increase the likelihood of developing urinary stress incontinence include:

  • previous pregnancy with vaginal delivery
  • obesity
  • chronic coughing
  • heavy lifting
  • frequent straining
  • increased urine output with excess fluid intake or taking “water pills”
  • primary urinary tract problems including infection and tumor (bladder tumors are unusual)
  • certain medications you may be taking
  • estrogen (hormonal) deficiency
  • immobility such as with arthritis

Suburethral Sling Surgery

The suburethral sling may be performed under spinal, epidural, or general anesthesia – but usually with you asleep. You will be placed in a position similar to that for a pelvic examination, and a small (3/4″) incision is made in the anterior vaginal wall just below the mid-urethra (the urethra is the tube leading out from the bladder).  A special tape (prolene mesh) is looped under the urethra. The two ends of the tape are anchored into the back of the pubic bone. The tape is now “U”-shaped, supporting the urethra. The small incision are closed. Other surgical procedures, if appropriate, may be performed at the same time as the sling.  This show a photo of the sling Dr. Biggerstaff uses.

Altis
You can see the small anchors at both ends of the mesh that do a great job holding the sling in place.

The advantages of the suburethral sling over some other procedures in treating urinary incontinence may include shorter operating time, quicker recovery time, and better long-term results.

The likelihood of success of the sling support procedure is reported to be 80-90% in most cases.

As with other surgical procedures to treat urinary incontinence, non-surgical alternatives may include:

  • lifestyle modification: quit smoking, lose weight, allergy treatment
  • Kegel’s exercise: regular contraction of the muscles that allow you to stop urine in mid-stream may reduce or eliminate incontinence
  • pessary use: usually a donut-shaped rubber or plastic device inserted into the vagina to support the bladder
  • hormonal (estrogen) replacement therapy
  • treatment with medication helps certain types of incontinence

Other surgical procedures such as the laparoscopic Burch procedure may treat urinary incontinence depending on the specific situation. Many times using a combination of several forms of treatment results in the best treatment for incontinence. These might include the non-surgical alternatives, plus the sling, plus an anterior repair.

The information provided by Advanced Healthcare for Women and E. Daniel Biggerstaff, III, M.D. is for informational purposes only. As each woman is unique, do not rely on this information for diagnosis and treatment. We cannot guarantee the accuracy of the content and advise that you see a qualified Health Care Professional for individual needs and care.