Vaginal Slings: When Surgery for Incontinence Goes Wrong

Health Professional

Being that I am a urologic surgeon, I routinely perform surgery on patients for incontinence. Unfortunately, no surgery is without its risks and complications. Before surgery, I always review risks and potential complications with patients, but when a patient has a bad outcome, they are always surprised. Now, even if you do not get the outcome you were hoping for, there are options for you to improve your outcome. There are many kinds of incontinence surgeries, but here I am going to focus on mid-urethral vaginal slings.

First of all, it is important that you let your doctor know that you are having problems or are unhappy with the outcome. One of the most frustrating things for me is when a patient comes to me after having been operated on by another doctor and now is seeing me to fix the problem. I am not saying that you don't have the right to seek help from another physician, but you should give your first doctor a chance to right things.

Some people, after incontinence surgery, are unable to urinate on their own, or have trouble urinating. This is called urinary retention. A large majority of these situations are self limited, and usually resolve on their own by about 6 weeks post-op. Some people will have to catheterize themselves. Many people are just so happy to be dry and not leak urine that catheterizing themselves is a good option. I often start people on a medication commonly used in prostate problems to help relax the urethra and help people urinate. Once in a while, a person will have to have another surgery to loosen the sling if that is what they have had. This procedure is called a urethrolysis. It is usually much less involved than the original surgery and the recovery time is pretty limited. Most people do well after this.

Unfortunately, sometimes the sling erodes either into the vagina, or worse, into the urethra or bladder. Surgery is a must because it can cause a lot of problems including chronic infections, and other issues. The surgery to remove the sling is similar to the above mentioned urethrolysis if it is only eroding into the vagina. If the sling is into the bladder, a more involved surgery may be necessary. You would know if you had an erosion if you were having malodorous vaginal discharge, pain with intercourse, recurrent bladder infections, persistent bleeding or generalized pain. You need to go see your surgeon to have another evaluation and possible removal. Usually the sling needs to be removed and then after some time to heal, meaning several months, the surgery can be repeated if you still choose to have your incontinence surgically treated.

Some people have successful treatment of their stress incontinence only to have worsening of, or new onset of urgency and urge incontinence. This happens because the bladder is responding to the fact that it can no longer leak whenever it wants. The bladder, in response to the sling starts to push harder and the bladder muscle gets stronger, and causes urgency and sometimes urge incontinence. I will often give people medicine for overactive bladder and this usually works. Most of the time, you only have to be on the medicine for 3-6 months to retrain the bladder. Once in a while, the medicines don't work and you have to have surgery to loosen the sling, as mentioned above, a urethrolysis.

Obviously, there are some other complications, but the previously mentioned ones are the most common. It is important to see medical attention from your surgeon if you think you are having problems from your surgery. It is also appropriate to get a second opinion before undergoing surgery again too. I hope you find this helpful. Good luck