Incontinence slings, or minimally invasive slings, are indicated for those with stress incontinence. A small incision will be made along the urethra where a narrow strip of polypropylene mesh is surgically placed under the urethra. The mesh will then be anchored into the body. The sling cradles the urethra in a position that mimics the normal anatomy allowing for more support and prevents accidental urine leaks. The placement of the sling is generally performed in an outpatient surgery setting taking less than an hour to complete the surgery.
Position Statement on Mesh Midurethral Slings
The American Urogynecologic Society (AUGS) and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) leaders jointly developed a Position Statement on Mesh Midurethral Slings (MUS) for Stress Urinary Incontinence which has been approved by the Boards of both societies.
The statement strongly supports the use of the mid-urethral sling in the surgical management of stress urinary incontinence. With this statement the organizations hope to clarify the confusion that has resulted from the advertisements by lawyers recruiting women with transvaginal mesh placed for both prolapse and incontinence.
Click here to download the entire statement as an Acrobat PDF.
Frequently Asked Questions regarding Mesh Midurethral Slings
Click here to download an Acrobat PDF file produced by AUGS and SUFU that addresses Frequently Asked Questions about Mesh Midurethral Slings for Stress Urinary Incontinence.
What to expect after your surgery?
- This procedure is minimally invasive and patients experience little pain.
- If you are unable to urinate after your procedure you may go home with a catheter. You will be instructed to follow up with your provider in 1 to 2 weeks for catheter removal.
- On the day after surgery it is very important to get out of bed and begin walking. This will help prevent Deep Vein Thrombosis (DVT). Please follow the DVT prevention handout.
- Your bowels may be sluggish after surgery and pain medication can increase constipation. Follow your postoperative bowel program for the next 6 weeks. It is very important to avoid straining post sling placement.
- You may have vaginal bleeding for up to 4 to 6 weeks that requires a panty liner. If you are saturating more than 4 to 5 pads per day you should be seen in clinic.
- Use your pain medication as directed if needed.
Activity and postoperative restrictions
You should be able to return to your normal activities within 1 to 2 weeks. If you are too active during your first few weeks after surgery, you may develop swelling at the urethra requiring a foley catheter to be placed.
- Use stairs gently for the first week.
- No heavy lifting, pushing, or pulling over 10 lbs for 6 weeks.
- No sexual intercourse for 6 weeks.
- No strenuous exercising for 6 weeks.
- Do not drive for the first 2 weeks after surgery. Do not be drive while taking narcotics.
- No baths for 6 weeks.
- No kegel exercises 4-6 weeks unless otherwise instructed by your physician.
- You should resume your pre-surgery medication unless told otherwise.
- Do not take any aspirin products for the first two weeks.
- If you are taking Warfrin or Plavix this should be followed by your primary care provider postoperatively. They will discuss with you when to resume medication and dosing recommendations.
- If you are taking pain medication or iron supplements you should also be taking a stool softener to keep from becoming constipated.
- If your pain is mild you can stop taking the pain medication and switch to acetaminophen.
- In addition, you should be following the postoperative bowel program for the next 6 weeks and using vaginal estrogen.
Medications and items to have at home before surgery
- Stool Softener
- Milk of Magnesia
- Vaginal Estrogen if applicable
You may return to your normal diet. You may want to avoid acidic foods and drinks that may cause burning with urination. Drinks with caffeine may cause frequency and irritation to your bladder. If not on a sugar or salt restricted diet drink 8 to 10 glass of water and Gatorade daily to avoid constipation and prevention of possible urinary tract infections.
- Fever over 100.5 Fahrenheit by mouth
- Pain not relieved by medication
- Rash, itching after taking pain medication
- Continued nausea and vomiting
- Abnormal swelling around operative site
- Increased redness, warmth, hardness around operative site
- Excessive drainage from surgical site
- Excessive bleeding from operative site (small amounts of oozing may be normal)
- Inability to urinate
- Swelling of the calf, ankle or foot
- Increased warmth of the leg
- Pain in the leg
- Bluish discoloration of the skin or leg
Postoperative follow up
You will need a follow-up appointment to monitor your progress in typically 6 weeks. You will be called for a postoperative follow up 1 to 2 days after surgery you can make your post operative appointment at that time or by calling and speaking to a receptionist. If you have a catheter your follow up appointment will typically be within 1 to 2 weeks after surgery and again in 6 weeks.