Surgery for the Treatment of Urinary Incontinence

When conservative treatment options, such as medications or biofeedback, are ineffective, surgery may be recommended for treating urinary incontinence, especially if the incontinence is due in large part to prolapse of one or more pelvic organs.

During the procedure, a narrow strip of natural or synthetic material is used inside the pelvic area to support the bladder neck and the urethra (the tube that carries urine from the bladder) or other pelvic organs. This “sling” helps keep the urethral sphincter closed, especially when coughing, sneezing, lifting or exercising.

Sling procedures are available for both men and women with stress incontinence, particularly those who have an intrinsic sphincter deficiency (ISD).

How Sling Surgery Works

A sling made of natural biological tissue or synthetic material is wrapped under the neck of the bladder and both ends are attached to the abdominal wall or pelvic tissue. The sling is tightened to raise the bladder, providing needed support to the organs and enabling the urethral sphincter to close.

With this procedure, the surgeon typically makes two incisions – one in the vagina (for women) or in the space between the scrotum and anus (for men) and one in the abdominal wall just above the pubic hair or in the crease of the thigh.

Variations of the sling procedure:

  • Adjustable slings – This is similar to a conventional sling except that after putting the sling in place, adjustments can be made – both during the initial surgery and at a later date – based on patient feedback.
  • Tension-free slings – This is similar to a conventional sling procedure except that no stitches are used to attach the sling and the sling is made from a synthetic strip of mesh. The sling is held in place by pelvic tissues at first; then scar tissue develops around the mesh to keep it in place.
  • Bladder neck suspension – This is not technically a sling procedure, as it uses no external material, but like a sling, it involves surgery to raise and support the urethra and bladder neck. In this procedure, the tissue near the bladder neck is stitched directly to a ligament near the pubic bone or in the cartilage of the bone itself.

Often sling surgery can be performed using a thin, lighted tube called a laparoscope inserted through a small incision. Due to post-operative swelling, a catheter (a small tube) may be left in place for a day or two to help in urination.

Proven Effectiveness and Safety

The sling procedure is highly effective for many patients with urinary leakage problems related to sphincter inadequacies. Recovery time is typically two to six weeks, and patients are advised against lifting heavy objects or engaging in strenuous activity for about six weeks. The procedure is not appropriate for all patients.

Sling surgery has risks similar to any surgical procedure, including swelling, bruising, bleeding, and infection. Some patients report prolonged period of urination difficulties and rejection or erosion of sling material.

Recently there has been some concern about some surgical mesh materials used in tension-free procedures.1 Many of these concerns can be avoided through careful patient screening by the physician and proper selection of sling materials. Please discuss this and all your concerns with your doctor.

The MyMichigan Difference

  • Our board-certified urologists and gynecologists are specially trained in the latest and safest sling procedures.
  • MyMichigan facilities are conveniently located in safe and friendly communities, with easy access and parking.

Are These Options Right for You?

Surgery is not right for every patient. Only your health care provider can determine if it is right for you.

Your Next Steps

  • For more information about surgery for incontinence, talk to your physician. For a physician referral, visit our Find a Doctor section, or call the MyMichigan Health Line at (989) 839-9090 or toll-free at (800) 999-3199.

[1]August 31, 3011 article in Common Health warned about complications from surgical mesh:

July 13, 2011 FDA update warning of serious complications from surgical mesh reported in some women: