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

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

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

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.

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

Smoking
Drinking
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:

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.

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 medication 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.

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

At Home

Avoid lifting and strenuous exercise for 6 weeks after surgery. This will allow healing to take place. Do not return to sexual activity or use tampons until your doctor says it is okay to do so.

Call Your Doctor

Contact your doctor if your recovery is not progressing as expected or you develop complications such as:

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 were 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.

RESOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases
https://www.niddk.nih.gov

Urology Care Foundation
http://www.urologyhealth.org

CANADIAN RESOURCES:

Canadian Urological Association
http://www.cua.org

The Canadian Continence Foundation
http://www.canadiancontinence.ca

References:

Surgical treatment for female stress urinary incontinence. National Association for Continence website. Available at: https://www.nafc.org/resource-center/surgical-treatment-for-female-stress-urinary-incontinence. Accessed December 18, 2017.

Townsend MK, Danforth KN, Rosner B, Curhan GC, Resnick NM, Grodstein F. Physical activity and incident urinary incontinence in middle-aged women. J Urol. 2008;179(3):1012-1016.

Urinary incontinence. Family Doctor—American Association of Family Physicians website. Available at: https://familydoctor.org/condition/urinary-incontinence. Updated April 2014. Accessed December 18, 2017.

Urinary incontinence. Urology Care Foundation website. Available at:
...(Click grey area to select URL)
Accessed December 18, 2017.

Urogynecologic surgical mesh. US Food & Drug Administration website. Available at: https://www.fda.gov/downloads/medicaldevices/safety/alertsandnotices/ucm262760.pdf. Accessed December 18, 2017.

6/2/2011 DynaMed Plus Systematic Literature Surveillance http://www.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.

Last reviewed November 2018 by EBSCO Medical Review Board Adrienne Carmack, MD
Last Updated: 12/20/2014

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