Stress Urinary Incontinence: Having Midurethral Sling Surgery

Stress Urinary Incontinence: Having Midurethral Sling Surgery

To help treat stress urinary incontinence (SUI), your surgeon may perform a procedure called midurethral sling surgery. A “sling” of tissue is placed under the urethra. The sling (tape) is made from a mesh of synthetic (manmade) material. When the tension of the tape is adjusted, urine should no longer leak. Your surgery will take about 60 minutes. You will be asked to do some things at home to prepare for surgery. Below are guidelines to help you get ready. If you have any questions, call your nurse or doctor.

The Weeks Before Surgery

  • Have any tests that your doctor orders.

  • Tell your doctor about aspirin and other medications, vitamins, or herbs you take. Ask if you should stop taking them before surgery.

  • Stop smoking to help reduce your risks during surgery.

  • If you have been given any prescriptions to fill, do this before surgery.

The Night Before Surgery

  • You may be asked to give yourself an enema. This cleans out your bowels for surgery. You’ll be told how to do it.

  • Do not eat, drink, or chew anything after the midnight before surgery, as instructed. This includes water and chewing gum. But if you’ve been told to take any medications, swallow them with small sips of water.

The Day of Surgery

Arrive at the hospital a few hours before surgery as directed. Have someone drive you there who can also stay during the surgery, and drive you home. At the hospital, your temperature and blood pressure will be taken. In some cases, tests may be done. Then, you will receive one or more IV (intravenous) lines. These lines give you fluids and medications before, during, and after surgery. Some of your pubic hair may be removed. Tight stockings may be put on your legs to help prevent blood clots.

About Anesthesia

To keep you pain-free during surgery, you’ll receive anesthesia. General anesthesia allows you to sleep. Local anesthesia numbs the area that will be operated on. Before surgery, you’ll meet with the anesthesiologist or nurse anesthetist. He or she can tell you what kind of anesthesia you will receive and answer questions you may have.

During the Procedure

Side view cross section of female lower abdomen and pelvis showing bladder, pubic bone, urethra, pelvic floor muscles, vagina, uterus, and rectum. Sutures connect tape (sling) around urethra to tissue above pubic bone. Incision site is on skin just above pubic bone.

  • Two small incisions are made in the lower part of the abdomen (belly), near the pubic hairline. Another small incision is made in the front wall of the vagina.

  • Working through the incisions, the surgeon places the tape like a hammock under the urethra. The two ends of the tape emerge through the abdominal incisions.

  • If you’re given local anesthesia, your surgeon may tell you to cough so that the tension of the tape can be adjusted.

  • When the tension is adjusted, the ends of the tape are cut and remain below the skin in the tissue of the abdominal wall. The healing process of the incisions holds the ends of the tape in place.

  • The incisions in the abdomen and vagina are closed with sutures (stitches).

Risks and Complications

The risks and complications of this procedure may include:

  • Infection

  • Bleeding

  • Risks of anesthesia

  • Blood clots

  • Damage to nerves, muscles, bladder, or nearby pelvic structures

  • Difficulty urinating

  • Urinary urgency

  • Problems with sling (tape)