Do I Need a Mid-Urethral Sling if I Only Leak on Occasion?

You came in for a vaginal bulge and you only leak every once in a while when you cough or sneeze but it doesn’t really bother you…so why did we recommend prolapse repair with a mid-urethral sling (TVT)? When the bladder drops (cystocele) or the uterus protrudes down into the vagina (uterine prolapse), sometimes this kinks the urethra and decreases the amount or even prevents stress urinary incontinence (SUI). When the bulge or prolapse is repaired either with vaginal prolapse repair or sacrocolpopexy, this frees the urethra and may result in an increase in SUI or new onset SUI in women who did not experience leakage prior to their repair. This is why a TVT is usually recommended in cases of minimal  or no SUI. In women without SUI, a prophylactic sling may be recommended after evaluation of bladder function with urodynamics study, to prevent a new onset of leakage.