Tensioning of a Mid-Urethral Sling- What Happens if the Sling is Too Tight

All mid-urethral slings are placed tension free. Tension varies from patient to patient. For example, in a patient with Intrinsic Sphincteric Deficiency (ISD) of the urethra in addition to movement of the urethra, the sling is placed tighter than in a patient who only has movement of the urethra.

Sometimes after a mid-urethral sling, patients have difficulty voiding. When that occurs, the sling needs to either be removed or loosened.

When patients are referred after a sling with difficulty voiding, and it has been a while since the operation, cystoscopy is often performed to look for evidence of obstructive voiding. During cystoscopy, the inside of the bladder and urethra are evaluated with a small camera. The bladder wall thickens in patients with obstructive voiding and this can be seen on cystoscopy. Further, cystoscopy can also ensure that the bladder itself is normal and that the sling did not perforate the bladder. Urodynamics is occasionally performed as well to obtain pressure readings during voiding.