Surgery

Postoperative Considerations for Most Procedures. Following most standard procedures, patients usually leave the hospital on the second or third day, but need a urinary catheter for about 10 days. Newer procedures may require shorter stays and less intensive postoperative care.

Complications after surgery include:

• Some risk of damage to the surrounding nerves or vessel. This can result in internal sphincter deficiency. (In some cases it may already have been present before the operation.)
• Difficulty in urinating from surgical overcorrection. (This may require additional surgery.)
• Poor wound healing.
• Adhesions (scar tissue) that obstruct the urethra. This complication is higher with older standard procedures.
• Vaginal abnormalities (prolapsed vagina).

Sling Procedure

A sling procedure may be a good option for severe stress incontinence in women who have either intrinsic sphincter deficiency or urethral hypermobility. The method is even proving to help women with mild to moderate incontinence and certain young girls with severe incontinence. It may also be useful for managing female urge incontinence. Sling procedures are also available for men who experience incontinence after prostatectomy. However, research on the benefits of sling procedures has been mixed. Studies comparing the procedure to other standard techniques are needed.

The Percutaneous Sling Procedure for Women. The procedure generally works as follows:

• The surgeon makes an incision above the pubic bone and removes a layer of abdominal fasci (tissue that covers muscle fibers). This muscle strip is set aside and later serves as the sling. (The use of fasci taken from a cadaver or synthetic slings are also being investigated. However, the natural muscle strip may last longer than some of the common synthetic materials.)
• The surgeon makes an incision in the vaginal wall. The piece of muscle fiber or material is attached under the urethra and bladder neck, somewhat like a hammock, and secured to the abdominal wall and pelvic bone.
• This sling then compresses the urethra back to its original position. The sling must be supportive without being too tense, which can cause urinary obstruction.