Mid-Urethral Sling

Mid-Urethral Sling for Stress Urinary Incontinence

The gold standard of treatment for stress urinary incontinence is a mid-urethral sling.

Mid-Urethral Sling

Mid-Urethral Sling

The polypropylene sling is placed without tension around the urethra. The sling treats incontinence by providing support under the urethra when abdominal pressure is increased. Activities that stress the urethra include coughing, laughing, running, walking or jumping. The procedure typically takes about 30 minutes and is performed in an outpatient surgical setting in which the patient goes home the same day.

Dr. Shashoua has performed mid-urethral slings since 2001. The sling is made of permanent, synthetic material providing a permanent repair. Dr. Shashoua performs over 200 sling procedures a year.

Success rates of the mid-urethral sling for patients with no prior incontinence surgery is over 90%. Success rates in patients with a prior incontinence surgery may be lower, depending on the individual patient. Complications are unusual but can include bladder injury, bleeding, infection and urinary retention. Other issues that are rare but have been reported include vaginal pain or pain with intercourse after healing. Any time there is sling material placed within the vagina, there is a potential risk of sling exposure. If the sling is placed in the appropriate anatomic plane, the risk is low, but can occur if the incision does not heal properly. In rare cases reoperation or partial sling removal may be indicated.
Another approach for the treatment of stress incontinence is an autologous pubovaginal sling using either abdominal fascia or tensor fascia lata from the upper thigh of the patient. Prior to the synthetic mid-urethral slings, an autologous sling using the patient’s own tissue was the gold standard procedure for stress urinary incontinence. Currently, an autologous sling is placed in cases where a mid-urethral sling has failed, or when the patient is not a candidate for a synthetic sling.

Slings are not used to treat pelvic organ prolapse (cystocele, rectocele, or uterine prolapse). If pelvic organ prolapse is present and symptomatic, a prolapse repair surgery such as da Vinci Sacrocolpopexy or VVaginal Prolapse Repair is also done at the time of the sling.

Mesh Concerns

Transvaginal mesh, which was introduced in the early 2000’s to treat stress urinary incontinence, has received much attention since the FDA first cautioned against its use in 2008. This culminated in the recent removal of the remaining transvaginal mesh from the market by the FDA in April 2019. There has been some confusion over the type of mesh that the FDA banned and the mesh that is still approved for the treatment of stress urinary incontinence. The mesh used for stress urinary incontinence is not

My treatment was the Da Vinci Sacrocolpoperineopexy and Mid-Urethral Sling, with surgery being performed by Dr. Shashoua and his staff at Austin Urogynecology. My conditions I dealt with were Cystocele, Rectocele, Pelvic Organ Prolapse and Urinary Incontinence… When I could no longer ignore the several conditions I was struggling with any longer, I was referred to Dr. Shashoua's office. …I am now past my six week follow-up and feel great. It is wonderful to cough and sneeze or jump around without leakage! I never had much pain from the surgery and after post-op check-up, was up and around with no problems. Dr. Shashoua and his staff have always been the best. So sincere and willing to answer any and every question you have. They all have been so informative, and have provided information when I didn't know what questions to ask. I feel very fortunate that I was directed toward Dr. Shashoua at Austin Urogynecology. Thank you so much Dr. Shashoua!

-Susan P.

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