Urethral Suspension—Sling Procedure
Urethral suspension is a surgery to correct stress incontinence in women. The procedure creates support for the tube that carries urine out of the body. The tube is called the urethra.
Female Bladder and Urethra
Reasons for Procedure
The goal of this surgery is to place a sling under the urethra. The sling will close off the urethra during stressors like laughing or sneezing. This will stop the uncontrolled leaking of urine.
Complications are rare, but no procedure is completely free of risk. If you are planning to have a urethral suspension, your doctor will review a list of possible complications, which may include:
- Reactions to anesthesia
- Inability to urinate
- Continued incontinence or recurrence of the problem
- Damage to other nearby organs or blood vessels
- Pain, such as during sexual intercourse
Sometimes, a surgical mesh is used in this procedure. This mesh has been linked to some problems during recovery. Talk to your doctor about medical devices used during surgery.
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
- Chronic disease such as diabetes or obesity
Prior pelvic or vaginal surgery may increase the risk of complications.
What to Expect
Prior to Procedure
Your doctor will try to find out why you are leaking urine through some or all of the following:
- Medical history—information about medications, illnesses, number of pregnancies, and previous surgeries; pattern of leaking and how it is affecting your life
- Urine sample—to look for the presence of infection or other problems
- Physical exam—includes a rectal and vaginal exam
Additional testing may be ordered to evaluate bladder function and urine flow, such as:
- Urine flow studies—a temporary catheter is placed to study bladder function
- Cystoscopy —a procedure done to view the inside of the bladder
Steps to take leading up to surgery:
- Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
- Arrange for a ride home from the hospital.
- Do not eat or drink anything after midnight the night before.
Description of Procedure
One or two small incisions will be made in the abdominal wall and vagina. A sling will be placed under the urethra and stitched into place. The sling can be made out of a synthetic material or tissue from your own body.
Immediately After Procedure
After surgery, you will be monitored in a recovery room. You will most likely have a catheter in place to drain your urine.
How Much Will It Hurt?
Anesthesia will block pain during the surgery. After surgery, you may experience some pain or soreness. You will be given pain medication to relieve the discomfort.
At the Hospital
At first, your urine may look bloody. This will resolve over time.
When you are able to empty your bladder completely, the catheter will be removed. You may be asked to get up and walk around.
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
There are also steps you can take to reduce your chances of infection such as:
- Washing your hands often and reminding visitors and healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
- Not allowing others to touch your incisions
Call Your Doctor
After you leave the hospital, contact your doctor if any of the following occurs:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
- Pain that you cannot control with the medications you have been given
- Cough, shortness of breath, or chest pain
- Severe nausea or vomiting
- Trouble urinating
- Pain, burning, urgency, or frequency of urination
If you think you have an emergency, call for emergency medical services right away
National Kidney and Urologic Diseases Information Clearinghouse
Urology Care Foundation
Canadian Continence Foundation
Canadian Urological Association
Incontinence. American Urological Association Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=143. Updated March 2013. Accessed October 28, 2014.
Surgical mesh. US Food and Drug Administration website. Available at: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm142636.htm. Updated October 6, 2014. Accessed October 28, 2014.
Surgical treatment for female stress urinary incontinence. National Association for Continence website. Available at: http://www.nafc.org/bladder-bowel-health/types-of-incontinence/stress-incontinence/surgical-treatment-for-female-stress-urinary-incontinence. Accessed October 28, 2014.
Townsend MK, Danforth KN, et al. Physical activity and incident urinary incontinence in middle-aged women. J Urol. 2008;179:1012-1016; discussion 1016-1017.
Urinary incontinence. American Association of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/urinary-incontinence.html. Updated April 2014. Accessed October 28, 2014.
6/3/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last reviewed December 2014 by Adrienne Carmack, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.