Sling Surgery for Incontinence

Sling surgery is the most common surgery that doctors use for treating urinary stress incontinence. The symptoms of urinary incontinence may be noticed while coughing, sneezing, or lifting. All these actions put pressure on the bladder and make you pee a little bit. In this surgery, the surgeon places the sling under the urethra (the tube through which the urine passes). Making some changes in lifestyle like doing Kegel exercise, losing weight, and practising pelvic floor therapy may help in reducing the symptoms of urinary incontinence. But, after trying all these, if you still have the signs of urinary incontinence, then sling surgery is the best recommendation for you. There are several types of sling procedures, like traditional and mid-urethral surgery. Both of them are highly safe and successful.

Sling surgery is performed for managing the urinary incontinence in males and females. The patients with urinary incontinence experience several symptoms, such as urinary leakage from coughing or sneezing or strong and sudden urge to urinate. There are several types of urinary incontinence. These are functional incontinence, urge incontinence, stress incontinence, overflow incontinence and mixed incontinence. 

There are several complications if the sling surgery is delayed. There is a progression of the urinary incontinence and the patients may experience several complications. Some of them are:

1. Significantly reduced quality of life
2. Social isolation
3. Loss of sleep
4. Anxiety and depression
5. Loss of interest in sexual activities
6. Increased risk of urinary tract infection
7. Skin diseases due to prolonged wet skin

Sling surgery in females

Mid-urethral sling surgery: It is also known as a tension-free sling. In this procedure, a thin strip of mesh is used to make the sling, and this sling is then put under the urethra by the doctor. The doctor may place this sling in any of the following ways:-

1. Retro-pubic method: The surgeon will make a small cut inside the vagina under the urethra. Two more tiny amounts are made above the pubic bone. Then the doctor will put the sling under the urethra and behind the pubic bone. Then these cuts are closed by using an appropriate method such as glue and stitches. 
2. Transobturator method: The surgeon will make a small cut inside the vagina under the urethra. Then the sling is inserted at the place using the needle.
3. Single-incision mini method: In this method, the surgeon makes a single cut, and the sling is placed through this cut. 
4. Traditional sling surgery: This is similar to mid-urethral surgery. The surgeon will take a stripe from the stomach or thigh to make the sling. Then two cuts are made, one in the vagina and one in the belly. Then the doctor will stretch through the cut in your stomach and then stitch it into the stomach wall. 

Sling surgery in males

In the male sling surgery, the surgeon positioned the mesh-like surgical tape around part of the urethral bulb. With this procedure, the urethra is repositioned through compression resulting in reducing the symptoms of urinary incontinence. It is a good technique to manage the symptoms of mild to moderate urinary incontinence. 

During the procedure, the surgeon makes an incision between the anus and scrotum. The urethra is exposed and the urethral bulb is wrapped with the surgical tape. The surgeon, with the help of the sling, moves the urethra to a new position. Through this procedure, support is provided to the bladder neck. 

1. Tell the doctor about the medicines you are taking, whether a supplement, herbal, or any other that you are taking without a prescription.
2. The surgeon may advise you to avoid having medicines like aspirin, ibuprofen, warfarin, and any other drugs that make the blood thinner and make it hard to clot. 
3. Stop smoking if you do that. 
4. Reduce the amount of alcohol intake
5. Do not eat anything after midnight on the day of the surgery.
6. Take medicines prescribed with a small amount of water. 
7. If the doctor orders any laboratory or imaging tests, complete them before the procedure.

1. You will be told the time of the surgery. Try to reach the hospital on time. 
2. When you arrive at the hospital premise, you will be checked in by hospital staff. 
3. After that, you will need to fill out a consent form before the surgery.
4. Hospital staff will then ask you to change into the surgical gown provided by the hospital.
5. An ID bracelet will also be tied to your wrist. This bracelet contains the name and date of birth of the patient. 
6. The staff may always ask your name and date of birth before giving you medicine and other services.
7. An IV is injected into your wrist. All the medicine is given through this IV infusion bottle. After this, you will be wheeled to the operation theatre.

1. The whole procedure is done under either general anaesthesia or spinal anaesthesia. Therefore, the patient will not feel any pain during the surgery.
2. A tube is placed in the throat of the patient to ease breathing during the surgery. 
3. A catheter is placed in the bladder to drain urine from the bladder.
4. All the vital signs like heart rate, respiratory rate, and corneal reflex are monitored continuously during the whole surgery.
5. The sling used is either taken from the patient body part or can also be taken from a donor.

1. After completing the surgery, the patient will be taken to the Post anaesthetic care unit (PACU). The patient remains there until they are back to consciousness.
2. All the vital signs like pulse rate, blood pressure, and respiratory rate are monitored regularly during this period. 
3. Once the patient is fully awake, the staff informs them about activities and exercises that the patient needs to do.
4. The time of discharge from the PACU depends upon the anesthesiologist.
5. The patient will be discharged either on the same day or the next day of surgery. 
6. Any stitches made at the surgery will be dissolved after a few weeks of the operation.

1. The doctor will provide you the first follow-up appointment data at the time of discharge. 
2. Never miss the follow-up appointment visit.
3. The doctor will evaluate your recovery and other complications, if any. 
4. The doctor may either withdraw some or all of the medications or continue them according to your recovery. 

Consult a doctor immediately if you notice side effects of the surgery like:-

1. Feeling pain during sex
2. Developing an infection related to urinary tract
3. Feeling pain during urinating
4. If the mesh is used, there are minimal chances that the mesh will start breaking in the vagina. However, if this happens, then call a doctor immediately. Generally, it is treated by using vaginal cream, but the doctor may also recommend surgery in some rare cases.
5. Bleeding from the site of incision
6. Blood clot
7. Infection