It's estimated that about half of all women are affected by stress urinary incontinence (SUI). In some cases, pelvic floor exercises, such as Kegels, can help. In more severe cases, or when the exercises just don't cut it, your doctor may recommend a "simple" surgery to support your urethra with a sling made of synthetic mesh or your own tissue. No matter how easy a doctor may think a procedure is, if you're going under the knife, chances are that you are going to need a little convincing. And rightfully so in this case, because it turns out that this treatment carries a few more concerns than originally thought, as more and more women, after under-going the sling surgery, seem to have a need for the surgery to be fixed, often requiring a follow-up surgery, and sometimes resulting in increased incontinence or urinary retention.
So, what exactly happens during this sling surgery? First, a brief anatomy overview: attached to the bladders of both men and women is a narrow, hollow tube called a urethra. The urethra is how the urine exits the body. Near the neck of the bladder there are muscles surrounding the urethra called "sphincters". The sphincters are responsible for keeping the urethra closed so that urine doesn't just come leaking out all the time (ideally, at least). If the sphincter muscles are weakened or damaged (which can happen during pregnancy, childbirth, or pelvic surgery), they may no longer keep the urethra tightly sealed, allowing urine to leak.
There are different ways to perform a sling operation. Some options for the incision site(s) are through the vagina, abdomen, near the belly-button, or above the pubic hairline. Some doctors use general anesthesia, but many use a local or regional anesthetic. There are also different types of slings, made from different materials. All of these options illustrate why it is so important to seek out a few different opinions before committing to the surgery. Different doctors will feel most comfortable performing the procedure in their own special way.
During the surgery, the small mesh sling (similar in width to a piece of gift-wrapping tape) is slung under the urethra. Following the procedure, the sling will provide resistance under the urethra to help keep it closed. Now, if only it were that simple. Actually, in many cases, it is just that simple. However, more and more stories are coming to light of complications in the wake of the surgery. In my next piece, I'll examine some of the ways that this surgery can go wrong.