Vaginal Sling Procedure for Stress Urinary Incontinence

You are considering or are scheduled for a surgical procedure called a vaginal or mid-urethral sling. The purpose of this procedure is to create a hammock of support and to prevent the urethra from opening when you cough, laugh, or sneeze. The procedure involves placing a piece of synthetic mesh (polypropylene mesh) under the urethra. Depending on your particular symptoms and preference, the procedure can be performed in one of two ways: just above the vagina on the lower abdomen (retropubic) or into the groin creases (transobturator technique). In October, 2008, the FDA issued a Public Health Notification regarding the use of synthetic meshes within the vagina for either pelvic organ prolapse or for stress urinary incontinence. El Camino Urology Medical Group encourages you to read this important patient safety document and address any concerns prior to scheduling surgery. Many patients also have a cystocele (dropped bladder), rectocele (herniated rectum into the vagina) or enterocele (herniated small bowel). Please see our section on pelvic organ prolapse for additional information regarding these conditions. If so, we may need to broaden the scope of your surgery and may use mesh to help in the repair. Your own tissues will typically become incorporated into the mesh in a few months. Should your own tissues appear too weak, we may recommend the use of other tissues or materials to help buttress the repair. The materials most commonly used are cadaveric tissue, porcine tissue, or synthetic mesh materials.

Through a vaginal incision, a strip of mesh is positioned under the urethra to create a supportive sling and to reduce or even eliminate urinary incontinence.

Pre-operative instructions for the vaginal sling procedure

You may be asked to see your family physician for a preoperative check up. If necessary, they will do an EKG, blood work, chest X-ray, and urine tests.

DO NOT TAKE ASPIRIN, BLOOD THINNING MEDICATIONS, VITAMINS AND HERBAL SUPPLEMENTS FOR
1 WEEK PRIOR TO SURGERY. This includes Coumadin, Heparin, Motrin®; Advil®, ibuprofen, Aleve®; glucosamine; vitamins A, C, D, and E; garlic; Echinacea; and omega-3 fatty acids. If necessary you can safely take Tylenol® for headaches or pain. Any other medication such as antibiotics, high blood pressure pills, and heart medications should be continued unless otherwise specified. Please discuss any concerns about stopping these medications with your family doctor.

DIABETICS: If you take NPH insulin, you should take ½ the regular dose the night before surgery but DO NOT take any NPH the morning of surgery.

DO NOT EAT OR DRINK ANYTHING AFTER 12 MIDNIGHT THE DAY BEFORE SURGERY. Any medications that must be taken the morning of surgery should be taken with a small sip of water.

What does surgery entail?

Vaginal sling procedures are almost exclusively done on an outpatient basis. However in special cases we may keep you for 23 hours in the hospital or an ambulatory surgery center. The procedures are done almost entirely through the vagina. A small incision is necessary just above the hairline or in the thigh creases for placement of some sutures or the mesh. Due to the small size of the incision and dissection, there is less discomfort and more rapid recovery in comparison to previous surgical treatments. We use absorbable sutures in the vagina which will dissolve in a few weeks. The retropubic sling requires sutures or bandages just above the hairline as well.

What are the risks and complications of the vaginal sling procedure?

Complications following this type of procedure are rare in the hands of surgeons with specific advanced training. The most common complications include bleeding and infection, injury to surrounding structures, pain, urinary retention (inability to urinate), recurrent or worsening incontinence, urgency or urge type incontinence. As outlined in the FDA article, erosions and infections of the graft material have been reported. These were predominantly associated with a specific type of mesh which has been removed from the market However, the risk still remains and this should be addressed with your surgeon at the time of consultation.

What happens after surgery?

Following surgery, your vagina will be packed for about 1 hour with a gauze roll in order to minimize bleeding. You may have a catheter exiting the urethra, although some patients can successfully void in the recovery area, and leave without a catheter. You will be given instructions on removing your catheter the morning after surgery (at home), if it is determined that you should be discharged with the catheter. The catheters are in place to allow you to empty your bladder, as there is swelling after surgery that often prevents this or makes it difficult. After the swelling subsides, you will gradually be able to urinate. Your normal pattern may not return for a few weeks, but this is normal in the course of events and not cause for alarm.

Discharge Instructions

Please click to download post-operative instructions for vaginal surgery.

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