Midurethral Sling:

A midurethral sling is used to treat stress urinary incontinence (SUI). SUI occurs with coughing, sneezing, laughing, running and walking, for instance. Some types of incontinence are more severe than others. Midurethral slings may be placed in a retropubic or transobturator approach typically. It may be up to 85-95% successful with studies showing so far 15 year of use. Other slings may be from your own harvested tissue or via a Burch procedure which is typically via an open abdominal approach. The midurethral sling is considered the Gold Standard to treat SUI and is FDA approved. Some risk factors include:

• Pregnancy after vaginal delivery
• Obesity
• Chronic coughing
• Heavy lifting
• Frequency straining
• Estrogen deficiency
• Radiation
• Trauma

Procedure: The small surgical procedure is typically performed under light general anesthesia, spinal, epidural and possibly local anesthesia. You would be placed in a position as for a gynecologic exam. A 2 centimeter incision is made just under the urethra in the vagina. Two small puncture site incisions are made at the groin area so that a needle-like introducer is used to attach the sling made of polypropylene (same material as general surgeons use for hernia repairs. The sling is not much more than the length and width of your finger. The sling supports the urethra without tension to avoid post operative symptoms lasting too long such as retention, frequency or urgency. Once in proper position, the small vaginal wound is closed and the 2 puncture sites are commonly closed with glue. Of course, as with any surgery there is a very small percentage of risks, including, but not limited to: bleeding, infection, pain, perforation, urinary retention, failure of the procedure.

Post-op instructions are typically not to lift more than 10 lbs for a month, expect a small amount of blood vaginally for a few days or so, groin pain for a couple days easily relieved with pain meds typically and otherwise soreness that may last a week typically. It is best not to become constipated or strain during the healing phase.