Sling Procedure

Stress incontinence (SI) is leakage that occurs with cough, sneeze or strain. It results from weakness of the valve mechanism, usually secondary to childbirth and aging.

All patients should have attempted pelvic floor exercises prior to surgery.

The urethral sling is designed to support the bladder neck and urethra, relocating this area to its normal anatomy.

The procedure is performed predominantly from below. Consequently, it is associated with less pain and superior recovery when compared to abdominal anti-incontinence procedures, allowing earlier return to normal function and shorter hospital stay. The wounds are smaller and are cosmetically excellent.

A number of materials have been used for the sling, both natural and artificial. The most proven and reliable is the patient’s own (autologous) fascia, the white, tough, fibrous tissue that forms tendons. A short length of this is harvested from the abdominal wall, a little above the pubis. Mobilising this fascia unfortunately causes some post-operative pain and delays recovery of normal function by a fortnight or so. General anaesthetic is required. It is perhaps the safest sling material to use in younger patients however.

As an alternative to “own” fascia, xenograft fascia is derived from pigs, highly purified, and available “off the shelf”. It forms a scaffold for the body to lay down scar tissue, and in time, the pig-fascia is absorbed away. As the operation is performed entirely from below, recovery is rapid and excellent, and hospital-stay is overnight only. There is a small risk of a transient allergic-type rash, which resolves spontaneously. Rarely, the sling will break before sufficient scar tissue has grown into it, incontinence may recur and the sling operation may have to be repeated.

An increasingly popular alternative is nylon-type mesh (TVT). Although placed under general anaesthesia, hospital-stay is overnight only. Recovery is rapid and excellent. There is a small risk (1%) of the mesh becoming infected or rejected, eroding into the vagina or urethra, and needing to be removed. The long-term safety, efficacy and risks of this material are not yet known, although mesh has been used safely elsewhere in the body, for over 20 years.

Pre-operatively:

• discontinue aspirin 1 week prior, other medications may need to be stopped
• nil by mouth from midnight, enema evening prior to surgery
• any shaving that is required will be performed in theatre

Post-operatively – early:

• day 1: diet, reinstate usual medications, remove pack and urethral catheter and home
• TVT / allogeneic fascia: resume full normal activity by 2 weeks
• Autologous fascia: normal activity by 4 weeks

Although most cases proceed without particular difficulty and have excellent outcomes, surgical complications occur overall in 5-10% of patients. The most bothersome are recurrent incontinence and voiding difficulties.

The list below details complications recognised as common or serious, but this does not include the rare and extraordinary.

This fact sheet complements the discussion during your consultation, which will apply your individual circumstances to the above facts.