Sling Surgery For Urinary Incontinence

How To Choose A Sling For Incontinence In Females

In general, you can choose a sling based on how much control you want to have over your bladder. A mid-urethral sling will give you more control than a traditional sling.

If youre looking for something that will last the longest and require the least number of follow-up visits, then a traditional sling is probably what you want.

In terms of recovery, a traditional sling is the quickest to recover from but may have more post-operative pain and complications than a mid-urethral sling.

On the other hand, a mid-urethral sling takes more time for your body to adjust to it before youll feel full relief from incontinence. But, it may also have fewer post-operative issues than a traditional sling.

Who Performs Incontinence Sling Surgery For Women

The following specialists perform incontinence sling surgery:

• Obstetrician-gynecologists specialize in womens health and pregnancy.

• Urologists specialize in diseases and conditions of the urinary tract and the male reproductive organs.

• Female pelvic medicine and reconstructive surgeons are urologists or gynecologists who have completed specialized training in womens pelvic floor disorders. Another name for this specialty is urogynecology.

What Are The Possible Complications Of Bladder Surgery

There can be complications of bladder surgery. You are at higher risk if you are over the age of 60 or designated female at birth. Possible problems include:

• Gastrointestinal problems: Abdominal surgeries can interfere with your bowel functions. Talk to your healthcare provider about how to handle GI issues.
• Reproductive health in men: Bladder cancer can spread to your prostate. During bladder surgery, your prostate may also be removed, which may impact your fertility.
• Reproductive health in women: If your uterus is removed as part of bladder cancer surgery, you wont be able to get pregnant.
• Urinary diversion: If you have a procedure that reroutes your urine , you may have complications. Pee could leak from the opening made in your body, and there could be an infection.
• Hormonal changes: If your bladder cancer has spread to your ovaries, they may need to be removed. Menopause will begin.
• Inability to urinate: Some people, especially women who have had more than their bladder removed, are unable to pee right away. This usually lasts no longer than a week. Youll be given a catheter and a leg bag . Your healthcare provider will teach you how to operate the equipment.

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What Treatments Options Are Available For Urinary Incontinence

Treatment options for urinary incontinence depend on the type of urinary incontinence being diagnosed. These include stress urinary incontinence, overactive bladder, urge incontinence and mixed incontinence. Most treatment plans will begin with the least invasive options and focus on nonmedical behavioral changes.

If these do not work or if the initial diagnosis calls for more aggressive treatment, other therapies including medications or surgery may be used. While typically thought of as an ailment that affects more women, men also have urinary incontinence, though the prevalence of it in men is lower than in women for all age groups. Many of the treatment options for men are similar to the treatment options for women.

Posterior Tibial Nerve Stimulation

Your posterior tibial nerve runs down your leg to your ankle. It contains nerve fibres that start from the same place as nerves that run to your bladder and pelvic floor.

It’s thought that stimulating the tibial nerve will affect these other nerves and help control the urge to pee.

A very thin needle is inserted through the skin of your ankle and a mild electric current is sent through it, causing a tingling feeling and your foot to move.

You may need 12 sessions of stimulation, each lasting around 30 minutes, 1 week apart.

Some studies have shown that this treatment can offer relief from urge incontinence and overactive bladder syndrome for some people, although there’s not enough evidence yet to recommend tibial nerve stimulation as a routine treatment.

Tibial nerve stimulation is only recommended in a few cases where urge incontinence has not improved with medicine and you do not want to have botulinum toxin A injections or sacral nerve stimulation.

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What Are The Risks And Potential Complications Of An Incontinence Sling Surgery

As with all surgeries, an incontinence sling surgery involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.

General risks of surgery

The general risks of surgery include:

• Anesthesia reaction, such as an allergic reaction and problems with breathing

• Bleeding, which can lead to shock

• Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.

• Infection and septicemia, which is the spread of a local infection to the blood

Potential complications of an incontinence sling surgery

There has been some concern about the safety of synthetic slings. Synthetic slings are used in some, but not all, types of incontinence sling procedures. Ask your surgeon about the type of sling you will have and if a procedure that does not use a synthetic sling is an option for you.

Potential complications of an incontinence sling procedure include:

• Rejection or breakdown of the synthetic material used for the sling

• Urination problems including frequent need to urinate, difficulty emptying your bladder, and worsening of urine leakage

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:

Preparation For The Procedure

Before you have a vaginal sling procedure, tell your surgeon about any medications youre taking. Your surgeon may ask you to stop taking certain medications a few days or hours before your surgery, including medications that thin your blood, such as warfarin, aspirin, and ibuprofen. They may also ask you to avoid eating or drinking anything for six to 12 hours before your surgery.

Be sure to dress in comfortable clothing and arrange for a ride home.

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Artificial Urinary Sphincter For Men

For extensive urinary incontinence in male patients, an artificial urinary sphincter may be recommended. This is a small ring filled with fluid that is surgically placed around the bladder. When the patient would like to empty his bladder, he presses a valve placed under the skin that will cause the ring to deflate and allow urine to flow from the bladder.

Risks Of Bladder Sling Surgery

There are known risks associated with the mesh implants used in sling surgery. One of the main concerns is that pelvic meshes can break into fragments that embed into your tissue, become dislodged, and potentially perforate neighboring organs. When this happens, not only does the incontinence continue, but women experience intense pain and discomfort, often ending up worse than before the surgery. These complications frequently require followup surgeries to fix the mesh or even remove the device entirely.

In 2019, the FDA ordered a halt to the sale of transvaginal surgical mesh implants for certain pelvic procedures, and in many countries, pelvic meshes have been outlawed completely. Recently, in-depth media coverage and large class-action lawsuits have shed light on the dangers of bladder sling surgery. However, many women dont know about the alternative, nonsurgical treatment options.

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Botulinum Toxin A For Overactive Bladder

Overactive Bladder symptoms are caused by the bladder muscle squeezing to empty out urine inappropriately, even when the bladder isn’t full. This causes urgency and incontinence. It often happens without warning and when you do not want it to for example, when hearing the sound of running water, or putting the key into the latch.

Initial treatment involves bladder training exercises with a physiotherapist, and lifestyle changes including relaxation techniques and removing bladder irritants from your diet. There are medications called Anticholinergics that are excellent at calming the bladder muscle and giving you more control. However, if these treatments fail, then BOTA is an option.

BOTA is injected under cystoscopic vision into the bladder muscle. It works by relaxing the muscle of the bladder wall , reducing urinary urgency and incontinence. Following treatment, the effect of the toxins effects last for several months before the muscles return to their normal strength .

It is a day-stay procedure and you can return to work once you recover from the anaesthetic . It usually requires repeat treatments.

Why Would A Woman Need A Bladder Sling

A bladder sling is effective in helping to correct urinary incontinence. It will also restore your bodys natural ability to hold and control urine.

People who would benefit from a bladder sling include those who have complete urinary control loss and those who leak urine with activity or physical exertion.

If youre a woman who is living her life in constant fear of leaks, then a bladder sling may be the answer to all of your problems! Talk to your doctor about having this procedure done today.

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Advantages And Disadvantages Of The Transobturator Retrourethral Sling

Of the transobturator retrourethral sling devices, most studies reported on the AdVance sling, which has relatively good outcomes. In particular, good results can be expected in patients who have good residual sphincter function and those who have mild-to-moderate PPI. Overall, relatively few complications occur and most of them are mild.

One disadvantage is that adjustment is impossible after surgery, and the success rate of the surgery may not be good in patients who previously had radiation treatment, those with severe PPI, or those who have a defect in the sphincter function.

What To Expect After Surgery

Urethral sling surgery can be safely performed in an outpatient surgery center. There is normally a 2-4 week recovery period, during which you should avoid doing too much activity to allow your body to properly heal.

Its likely you will feel some pain and discomfort where your incision is and you may feel some cramping in your abdomen. Your doctor will prescribe you medication to help with the pain during the first few days after surgery. If you continue to experience pain, be sure to contact your doctor immediately.

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What Will Happen During Surgery

• You may be given general anesthesia to keep you asleep and free from pain during surgery. You may instead be given local anesthesia to numb the surgery area. With local anesthesia, you may still feel pressure or pushing during surgery, but you should not feel pain.
• Your surgeon will check for correct placement of the sling. A Foley catheter may be placed to help you urinate until swelling from surgery goes away. The incision may be closed with absorbable stitches or medical glue.

What Kind Of Doctor Is Best

Start with your primary care doctor. Your doctor may recommend a specialist with certification in Female Pelvic Medicine and Reproductive Surgery , such as a gynecologist, a urologist or a urogynecologist, also known as a urogyn. A urogynecologist is a medical doctor who has completed a residency in obstetrics and gynecology or urology. He or she has received additional training and experience in evaluating and treating conditions that affect the female pelvic organs, as well as the muscles and connective tissue that support them. Common problems treated by a urogynecologist include urinary incontinence or leakage, pelvic organ prolapse and overactive bladder.

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Urinary Incontinence Treatments At A Glance

• Treatments for urinary incontinence depend on the type of incontinence, such as stress incontinence and overactive bladder, and range from lifestyle changes to surgery.
• When appropriate, treatment plans start with the least invasive method, which in many cases can include behavioral change by the patients.
• The Urology Care Foundation says a quarter to a third of men and women in the United States have urinary incontinence, and treatment options are similar for both sexes.

What Causes Stress Incontinence

The cause of stress incontinence is the weakening of muscle and other tissues that support the bladder and the muscles that regulate the release of urine. Stress incontinence affects up to 1 in 3 women. It can also affect men but is much more common in women. The most common cause of stress incontinence is brought on by childbirth, and one-third of all postpartum women develop symptoms.

Stress incontinence is a type of urinary incontinence, the unintentional loss of urine. Stress incontinence happens when physical movement or activity puts pressure on the bladder causing it to leak. These activities could be sneezing, coughing, heavy lifting or exercising.

Common causes of stress incontinence that can be treated by a sling include:

• Mothers of multiple children and women who gave birth vaginally are at greater risk for stress incontinence than mothers with only one child or when delivery was through surgical means.
• Women highly active in athletic activities requiring long distance running or extended periods of small, sharp impacts, such as running on hard surfaces, jumping repeatedly on a hard surface or heavy weight lifting.
• Aging, menopause or estrogen deficiencies in women, which can thin the urethra and weaken the pelvic floor.
• Injury caused by radiation in cancer treatment.

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How Successful Are Mid

Synthetic mid-urethral slings are the most studied surgery to treat stress urinary incontinence with over 2000 journal articles published regarding the results of slings. Large studies have shown mid-urethral slings to have a high success rate and low complication rate with durable effects.

Retropubic and transobturator mid-urethral slings cure or significantly improve stress urinary incontinence in 80 to 90% of women.

Urinary Incontinence: Vaginal Sling Procedure

Overview

The vaginal sling procedure is also called the pubovaginal sling procedure. Its a type of surgery used to treat urinary incontinence in women.

Urinary incontinence is the medical term for the inability to control your bladder. This condition leads to the leakage of urine. For example, you may experience urine leakage after coughing or sneezing. Or you may experience strong and sudden urges to urinate, which lead to urine leakage when you cant make it to a toilet in time. If you have severe urinary incontinence that affects your daily life, your doctor may recommend a vaginal sling procedure to treat it.

When you urinate, a circular-shaped muscle around your bladder relaxes and releases urine into your urethra. Your urethra is the tube that leads from your bladder to the outside of your body. In the vaginal sling procedure, your surgeon will use a piece of tissue or synthetic material to make a sling around your urethra. This will help keep your urethra closed and prevent urine leakage.

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Risk Of Bias In Included Studies

Details of the criteria used to assess the risk of bias and the ratings for each study are reported in the ‘Risk of bias’ tables that accompany the Characteristics of included studies. Further information on the risk of bias in included trials is shown in Figure 2 the ‘Risk of bias’ graph and Figure 3 the Risk of bias’ summary.

How Sling Treatments Prevent Stress Incontinence

Sling procedures use tissue from the patientâs own body or synthetic mesh to create a âslingâ or âhammockâ to provide support to the urethra. This helps keep the urethra stay closed and prevents leakage of urine.

The sling can also be made from donor tissue or animal tissue. However, CU Urogynecology does not use animal tissue slings. Most sling procedures rely on synthetic material or tissue from the patient, due to the human bodyâs predisposition to absorb donor and animal material, which can create problems.

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Behavioral Changes As Effective Incontinence Treatments

Patients are encouraged to make several changes to their daily routine that will likely improve their incontinence symptoms including the following.

• Re-training their bladder by waiting to go to the bathroom for about 10 minutes after the urge presents. The patient then slowly increases the amount of time delay before urination, with the goal of urinating every 2-4 hours.
• Double voiding, which is urinating, waiting a minute or so, then trying to empty the bladder once more. This helps to more completely empty the bladder.
• Scheduling urination for preset times rather than waiting for the urge.
• Exercising pelvic floor muscles with Kegel exercises to strengthen muscles that control urination.
• Exercise and healthy eating, patients should try to maintain a healthy weight, exercise, drink fewer fluids, and restrict the intake of alcohol, caffeine and acidic foods.

What Does The Procedure Involve

The male sling is a treatment for male stress urinary incontinence. It involves placement of a synthetic sling that supports the waterpipe . The procedure will involve a cystoscopic examination of the urethra and bladder and an incision in the area behind the scrotum , with two further small cuts in the groin crease.

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Types Of Sling For Incontinence In Females

There are two main types of sling for incontinence in females:

Midurethral sling and Traditional sling

• Midurethral sling: A mid-urethral sling, also known as a TVT sling or tension-free vaginal tape , is designed to help with stress incontinence. It works by repositioning the urethra so that its held up under the bladder rather than letting it sag down inside your body.
• Traditional sling: A traditional sling, or artificial urinary sphincter , works to tighten the muscles around the urethra to prevent incontinence. It can also be used for stress incontinence but is more commonly prescribed for those suffering from complete loss of bladder control.