Urethral Suspension—Sling Procedure

by Patricia Kellicker, BSN

Definition

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

Bladder and uretha female
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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.

Possible Complications    TOP

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:

  • Bleeding
  • Infection
  • 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.

Factors that may increase the risk of complications include:

  • Smoking
  • Any factors that affect your overall health

Talk to your doctor about any factors that may increase your risk.

What to Expect    TOP

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 medicines, 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:
    • Urodynamic testing (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 medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Aspirin or other anti-inflammatory drugs
    • Blood thinners, such as warfarin (Coumadin)
    • Clopidogrel (Plavix)
  • Arrange for a ride home from the hospital.
  • Do not eat or drink anything after midnight the night before.

Anesthesia

You may receive a spinal anesthetic to numb your lower body. General anesthesia may also be used, in which case you will be asleep.

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 Long Will It Take?

1-1.5 hours

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 medicine to relieve the discomfort.

Average Hospital Stay

You may be sent home the same day.

Postoperative Care

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.

At Home

Certain steps will allow healing to take place. General steps include:

  • Avoid lifting and strenuous exercise for six weeks after surgery.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Ask your doctor when it will be safe to have sex or use tampons.

To help ensure a smooth recovery, follow your doctor's instructions.

Call Your Doctor    TOP

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 medicines you have been given
  • Cough, shortness of breath, or chest pain
  • Severe nausea or vomiting
  • Trouble urinating
  • Pain, burning, urgency, or frequency of urination

In case of an emergency, call for medical help right away.

RESOURCES:

National Kidney and Urologic Diseases Information Clearinghouse
http://kidney.niddk.nih.gov/
Urology Care Foundation
http://www.urologyhealth.org/

CANADIAN RESOURCES:

Canadian Continence Foundation
http://www.canadiancontinence.ca
Canadian Urological Association
http://www.cua.org/

References:

Incontinence. American Urological Association Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=143. Updated January 2011. Accessed September 16, 2012.
Incontinence. American Association of Family Physicians website. Available at: http://familydocto.... Accessed September 14, 2012.
Surgical mesh. US Food and Drug Administration website. Available at: http://www.fda.gov.... Updated October 8, 2009. Accessed September 14, 2012.
Surgical treatment for female stress urinary incontinence. National Association for Continence website. Available at: http://www.nafc.or.... Updated July 2009. Accessed September 14, 2012.
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.
Urethral suspension. New York University School of Medicine website.Available at: http://www.med.nyu.... Accessed September 14, 2012.
Wein AJ. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2007: chap 67.
6/3/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: 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 September 2012 by Adrienne Carmack, MD
Last Updated: 09/26/2012