Introduction:
The urethra is a small tube-like structure through which urine passes out from the urinary bladder. Sling surgery is a common surgery to treat the unintentional loss of urine. This happens when movement or any activity, such as laughing, coughing, sneezing, running, or lifting something heavy, puts pressure or stress on the bladder, leading to a bit of urine leakage. Stress urinary incontinence is not related to any kind of psychological stress. Stress incontinence can be treated with a couple of conservative treatments. Treatments include lifestyle changes like exercise, weight loss, or insertion of devices through the vagina to support the bladder. When these traditional approaches do not work, surgery might be an option for stress incontinence.
What Is Urethral Sling Surgery?
In urethral sling surgery, the surgeon makes a sling out of the tissue. Then this 'sling' is placed under the urethra. The sling acts like a hammock, lifting and supporting the urethra and the neck of the urinary bladder (the sac that stores urine). This sling prevents the urine from leaking. In most cases, sling surgery reduces or stops urine leakage. Although surgery has its share of complications or risks, it might provide a long-term solution. Choosing a particular procedure depends on the benefit and risks involved with each process and one's health and treatment needs.
What Are the Things to be Considered Before the Surgery?
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Get a proper diagnosis. Different kinds of urine incontinence involve different therapies. For further testing, an incontinence specialist might be needed.
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The surgery might not be able to treat the sudden urge to pass urine. Additional treatments are required if one has mixed incontinence, stress incontinence, and an overactive bladder.
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Suppose one is trying to have a child, postponing the surgery until childbirth is recommended. The strain on the bladder during pregnancy and delivery might hamper the surgically fixed part.
What Is the Procedure of Urethral Sling Surgery?
This is the most common procedure done to provide support to the urethra. The sling is usually made from an artificial material or one's body's tissue. The surgeon will explain the risk and benefits of using different sling-place materials and approaches.
1. Tension-Free Slings - A tension-free sling is a mesh made from an artificial material known as polypropylene. The sling supports the urethra and is held in place with the help of tissues rather than stitches. During healing, scar tissue forms in and around the mesh, thus preventing it from moving. A few procedures are recommended for tension-free slings. They are:
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Retropubic Procedure - The surgeon makes a small incision inside the vagina to easily access the urethra. Two small incisions are made above the pubic bone, to the right and left of the center. A needle is used to pass each end of the sling from the vagina to the abdomen. The sling is stabilized in its place by the soft tissue along its path. Absorbable stitches are made close to the vagina where the incision was made, and the skin incision might be closed with the help of glues or stitches.
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Transobturator Procedure - The surgeon makes a small incision in the vagina and two small incisions in the left or right groin area. The rest of the surgical procedure is the same as the retropubic approach, but the mesh passes through the place of the hip in between the stomach and thigh rather than the abdominal wall.
- Both retropubic and transobturator procedures are effective procedures. However, the transobturator sling is inoperative in combination with other surgical repairs in the pelvic region.
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Single-Incision Mini Procedure - In this procedure, a single small incision is made in the vagina. A small mesh sling is suspended from the thigh muscles or other tissues lower in the pelvic area. The results of the one-incision mini procedure are generally less productive than the other procedures, and more research is needed to assess the productivity and safety of this procedure.
2. Conventional Slings - A traditional sling uses tissues from one's body to support the neck of the bladder. The tissue used to make the sling is obtained from the abdomen or thigh. A cut is made in the vagina to place the sling below the urethra at the neck of the bladder. Each end of the sling is then stitched to the abdominal wall through an incision in the abdomen. A conventional sling requires a larger incision than a tension-free sling. It usually requires a more extended recovery period and an overnight hospital stay. After surgery, while healing, a temporary catheter or tube might also be needed. There is a higher risk of difficulty in bladder emptying. Therefore it is carried out on women who had other procedures to check incontinence but are still experiencing urinary incontinence.
3. Suspension Procedures - Suspension procedures support the urethra or bladder neck by lifting the tissues around the urethra towards the pelvis. The most common suspension procedure is the Burch procedure. In the Burch procedure, one end of the surgical thread is attached to the external wall of the vagina, and the other is attached to the tissue near the top of the pelvic bones. The sutures hang the vagina to the pelvic tissue. The vagina is pulled up to support the bladder neck when the sutures are secured.
Suspension procedures are carried out through an incision in the lower abdomen or through many small incisions (laparoscopic surgery). The laparoscopic procedure uses a video camera and tiny instruments attached to the tube to perform the surgery. This procedure results in a shorter recovery but may not be as effective as open surgery.
4. Sling Surgery in Men - Sling surgery can be carried out in men. A small incision is made between the scrotum and the anus. Then the sling is put around the part of the urethral bulb (the enlarged portion of the urethra in men). This process will squeeze and lift the urethra, which helps to prevent leakage.
What Are the Risks Associated With Sling Procedures?
Like any other surgery, urine incontinence surgery comes with its risks. The possible complications include the following-
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Temporary difficulty in passing urine.
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Temporary urinary retention.
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An overactive urinary bladder.
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Wound infection.
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Difficult or painful sex.
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Surgical material sticking out into the vagina.
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Pain in the groin.
Conclusion:
Urethral sling surgery is a surgery for urinary incontinence. Surgery might be recommended if conservative treatments and exercises like kegel exercises or pelvic floor therapy are not working. The recovery takes around two to six weeks and differs for different individuals. Instructions on when to resume exercise and sex are also given. The prognosis of the surgery is good if the doctor's advice is diligently followed.
