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Bladder Sling Complications

Doctors use strips of surgical mesh called bladder slings to treat stress urinary incontinence (SUI) in women. Some of the complications linked to bladder slings include pain during intercourse, tissue erosion, organ perforation and vaginal scarring.

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Bladder sling surgery is a type of procedure that treats stress urinary incontinence (SUI). 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.

If bladder sling surgery goes well, some women leave the hospital on the day of surgery. Others may stay for one or two days. The stitches in the vagina dissolve in a few weeks, and most women can have sexual intercourse without discomfort within three months of surgery.

Some risks of bladder sling surgery are similar to risks during other surgery such as bleeding and blood clots. However, bladder slings have a risk of complications that include erosion, infection, organ perforation and vaginal scarring.

In December 2017, complications from a bladder sling turned deadly for one Canadian mom. Christina Lynn Brajcic died after the mesh sling became infected and led to sepsis — a serious blood infection.

In January 2018, New Zealand banned several vaginal mesh products, including the ALTIS single incision mini sling for SUI. Australia issued a ban in November 2017 that includes mini-slings.

Women who suffered complications are fighting to get the slings banned in the U.K. and the U.S.

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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

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.

synthetic vs. tissue mesh sling complication rates

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:
  • Discomfort
  • Constipation
  • Temporary bleeding
  • Irritation at the site of incision
  • Minor pain
Woman holding stomach in 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)
 
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Replay Video
Urogynocologist Christopher Walker goes over the complications associated with a bladder sling

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:
  • Infections
  • Internal bleeding
  • Organ perforation
  • Inflammation
  • 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.

Please seek the advice of a medical professional before making health care decisions.

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8 Cited Research Articles

  1. Albo, M.E. et al. (2007, May 24). Burch Colposuspension Versus Fascial Sling to Reduce Urinary Stress Incontinence. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMoa070416#t=article
  2. Chen, Z. et al. (2010, January-March). Comparison of Three Kinds of Mid-urethral Slings for Surgical Treatment of Female Stress Urinary Incontinence. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/20890856
  3. Cleveland Clinic. (2014, October 30). Male Sling Procedure. Retrieved from http://my.clevelandclinic.org/services/sling_procedure/hic_male_sling_procedure_for_urinary_incontinence.aspx
  4. Gerten, K.A. et al. (2008, June). Prolapse and Incontinence Surgery in the Older Woman. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270581/
  5. KK Women’s and Children’s Hospital. (n.d.). Burch Colposuspension. Retrieved from https://www.kkh.com.sg/HealthPedia/Pages/FemaleUrinaryDisordersBurchColposuspension.aspx
  6. Mayo Clinic Staff. Urinary Incontinence Surgery in Women: The Next Step. Retrieved from: http://www.mayoclinic.org/diseases-conditions/urinary-incontinence/in-depth/urinary-incontinence-surgery/art-20046858
  7. Rabin, R. (2009, May 4). Women Sue Over Device to Stop Urine Leaks. The New York Times. Retrieved from http://www.nytimes.com/2009/05/05/health/05tape.html
  8. U.S. National Library of Medicine. (2015, January 21). Urinary Incontinence – Vaginal Sling Procedures. Retrieved from https://medlineplus.gov/ency/article/007376.htm
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