Stress urinary incontinence is the involuntary loss of urine caused by physical activities, such as laughing and sneezing. It primarily occurs in women because the urethra – the tube that carries urine out of the body – is shorter in women (2 inches) than men (10 inches). Pregnancy, childbirth and menopause can increase the risk of SUI.
Bladdery sling surgery is a type of procedure that treats stress urinary incontinence. Surgeons use a strip of transvaginal mesh, your tissue or animal tissue, to create a bladder sling that acts like a hammock to support the urethra and bladder. The support keeps the urethra closed, preventing leaks.
When successful, a bladder sling procedure prevents leakage during normal activities. Some women continue to experience minor leaks, which may be a sign of a different condition. Bladder slings are not always permanent solutions. Leaks may come back in the future.
Some risks of bladder sling surgery are similar to risks during other surgery. Those risks include bleeding, blood clots, breathing problems and infections. However, bladder slings have additional risks. They may cause changes to the vagina, damage organs or make it difficult to empty the bladder.
Bladder slings made from synthetic mesh, also called transvaginal mesh, are riskier than other slings. The risk of complications from transvaginal mesh include erosion, organ perforation and vaginal scarring.
Recovery from bladder sling surgery may take months, but most symptoms subside in a few weeks. Bleeding from the vagina should stop within hours of surgery. Some women leave the hospital on the day of surgery, but others stay for one or two days. The stitches in the vagina dissolves in a few weeks, and most women can have sexual intercourse without discomfort within three months of surgery.
Types of Bladder Sling Surgery
Surgeons create bladder slings from strips of tissue or synthetic material, such as transvaginal mesh, to create a pelvic hammock around the bladder neck and urethra. The U.S. Food and Drug Administration has approved bladder slings that can be used in a variety of surgeries to treat stress urinary incontinence.
The most common types of bladder sling operations include:
- Tension-free vaginal tape (TVT) sling: This outpatient procedure uses a polypropylene mesh tape, which acts as a sling under the urethra and is held in place by the patient’s own tissue rather than stitches. This debuted in 1996.
- Transobturator tape (TOT or TVT-O) sling: This tension-free surgery has less risk of bladder and bowel injury in comparison with the TVT sling. It was invented in France and brought to the United States in 2002.
- Mini-sling: This procedure has less risk of complications relative to the previous two because it eliminates the need for abdominal or groin incisions. In this procedure, a small single vaginal incision is made and a mesh tape is placed in a U-shaped configuration in the mid-urethra. It is the newest technology and was released in 2006.
The most common alternative to bladder sling procedures is Burch colposuspension. This procedure was the most popular technique before bladder slings became popular. It involves using sutures to lift the bladder neck up to stronger ligaments.
Common Types of Bladder Slings
Bladder slings made from human tissue are less popular among surgeons because they have a higher rate of short-term complications than synthetic mesh. Slings made from tissue are also more likely to fail, leading to recurrence of symptoms. However, the complications associated with slings made from tissue are not as serious as the ones associated with synthetic mesh.
Slings made from transvaginal mesh are less popular today than they were a decade ago because they have a high rate of complications. Some mesh bladder slings were pulled from the market after women who experienced complications filed lawsuits against transvaginal mesh makers.
ObTape, a bladder sling manufactured by Mentor Corporation, was one of the first bladder slings. It entered the market in 2003, but it caused several complications. It was made of dense materials, and the mesh’s thick weave did not allow the tissues around it to receive nutrients. Many women’s bodies rejected the device. Mentor withdrew the synthetic mesh device from the market in 2006.
Several other companies also made or continue to make bladder slings from synthetic mesh.
Bladder sling brands include:
- Johnson & Johnson’s Gynecare
- Bard’s Pelvilace and Uretex
- American Medical System’s MiniArc and BioArc
- Boston Scientific’s Advantage
- Coloplast’s Novasilk
Johnson & Johnson discontinued its Gynecare bladder slings in June 2012, but the company said the withdrawal from the market was not related to safety issues.
Side Effects and Severe Complications of Bladder Sling Surgery
Overall, bladder sling surgery is associated with intermediate risks. The risk of death is very low in most women. Mortality rates are highest among women older than 80, but the death rate is lower than 5 percent.
Most side effects of bladder sling surgery are minor.
Typical side effects include:
- Temporary bleeding
- Irritation at the site of incision
- Minor pain
The surgery does have a high rate of complications, though. A 2010 study of bladder sling procedures analyzed the outcomes of 187 women who received bladder slings to treat stress urinary incontinence.
The complication rate was:
- 9 percent for transobturator vaginal tape out-inside (TOT)
- 2 percent for transobturator vaginal tape inside-out (TVT-O)
- 6 percent for tension-free vaginal tape (TVT)
Complications from the procedures included discomfort urinating, hematomas (swelling blood clots) and dysfunction of lower limbs. TVT was the only procedure associated with bladder perforation.
The transvaginal mesh that’s used in some bladder slings has been associated with complications after surgery.
Complications from bladder slings made of mesh include:
- Internal bleeding
- Organ perforation
- Recurring incontinence
The most serious complications occur when mesh erodes into nearby organs, such as the vagina, bladder and rectum. The mesh can puncture an organ, causing severe pain and increasing the risk for organ failure.
A New England Journal of Medicine study compared bladder sling procedures and an older technique called Burch colposuspension. Bladder slings had higher success rates, but they also had higher rates of complications. The most common complications in that study were urinary tract infection, urge incontinence, voiding dysfunction and the need for revision surgery.
Bladder slings are not meant to be removed, so women considering a surgery using a bladder sling should consider the risk of immediate and future complications. If transvaginal mesh from the sling erodes and damages other organs, multiple surgeries may be required to repair the damage. Before considering bladder sling surgery, doctors usually recommend more conservative treatments, such as pessaries or pelvic floor therapy, to treat stress urinary incontinence.