What is a bladder sling?
A bladder sling, also known as a urethral sling, is a surgical procedure that helps treat stress urinary incontinence (SUI). The sling supports the muscles that help the urethra and bladder neck close. The goal of the procedure is to reduce the leaks that happen when you laugh, cough, sneeze, lift heavy items or exercise.
Types of bladder sling
There are two types of urethral slings used to treat urinary incontinence:
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Midurethral sling
This is the most common surgery for SUI. It involves placing a narrow strap made of synthetic mesh under the urethra, acting like a hammock to lift and support the urethra and bladder neck.
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Traditional sling
In this procedure, a strip of your own tissue, usually taken from the lower abdomen or thigh, is used to create the sling. The sling is threaded behind the pubic bone and under the urethra through two tunnels made on either side of the vagina. The ends are then stitched in place through an incision in the abdomen, lifting the urethra.
Why might I need bladder sling surgery?
A bladder sling is used when other treatments are unsuccessful and can be performed for both men and women:
Women
A vaginal sling procedure is used to treat stress urinary incontinence, which is urine leakage that occurs when laughing, coughing, sneezing, lifting or exercising.
Men
A male sling procedure is used to treat urinary incontinence after prostate surgery, particularly for men who have had a radical prostatectomy for prostate cancer. It's best for men who wet one to three pads per day or less.
How to prepare for bladder sling surgery
Before your surgery, you'll undergo a preoperative evaluation to help the surgeon determine the best method for creating and placing your urethral sling. During this time, your healthcare provider will also provide detailed instructions on how to prepare for the procedure.
How to prepare
- Stop taking certain medications (e.g., aspirin, ibuprofen, blood thinners) as advised by your care team.
- Quit smoking at least a week before surgery to reduce complications; even quitting a day before helps. Ask your care team for support if needed.
- Arrange for someone to drive you home after the procedure, as you will receive anesthesia.
The bladder sling procedure
Bladder sling surgery is usually an outpatient procedure. Once you arrive and check-in, you can expect the following:
Before the procedure
Your care team will give you instructions about when to arrive, when to stop eating and drinking, and whether you should take any medications on the day of your procedure. Follow them closely.
You can shower before you arrive but do not use any lotions, perfumes or deodorants. It’s also a good idea to remove nail polish.
During the procedure
You will receive anesthesia before the surgery begins. You may receive general anesthesia that puts you to sleep or spinal anesthesia that numbs you from the waist down. Your surgical team will also insert a catheter to collect urine.
Your surgeon will make one incision through your vagina to access your bladder and one or two small cuts in your groin. The surgeon inserts the sling through the incision in your vagina and places it under the urethra. They then thread the ends of the sling through the incisions in your groin and adjust the tension to provide the appropriate amount of support. Your body will surround the sling with new tissue to help hold it in place. Finally, the surgeon closes the incisions.
Bladder sling surgery is generally expected to take around 30 minutes.
After the procedure
You will move to a recovery room while you wake up from anesthesia.
If you’re having an outpatient procedure, your surgeon will let you go home as soon as you can empty your bladder and your pain is under control. This generally takes a few hours. If you have difficulty emptying your bladder, you may need to continue using a catheter for a short time.
It can take three to 10 days to recover from a midurethral sling procedure. Traditional sling procedures may require more time.
Take it easy as you recover and resume your normal routine once you no longer feel tired. Avoid intense exercise and heavy lifting for six weeks to help your body heal. Your surgeon can let you know when it’s safe to have sex and use tampons again.
As you heal, keep an eye out for signs of the following complications:
- Bleeding: A sign of a hematoma (clotted blood that collects inside the body)
- Burning, stinging or urgency when you urinate: A sign of a urinary tract infection
- Problems urinating: Often related to swelling around the urethra
- Unusual vaginal discharge: May be the result of mesh entering the vagina, which your surgeon can correct