What is an incontinence sling procedure?

An incontinence sling procedure is a surgery to treat stress incontinence. Stress incontinence is the leakage of urine during physical activity, such as coughing, sneezing, or heavy lifting. An incontinence sling procedure places a natural or synthetic sling under your urethra. Your urethra carries urine from the bladder to the outside of your body. The sling supports and compresses the urethra to control urination. 

An incontinence sling procedure is also called a vaginal or bladder sling procedure. It is a surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having an incontinence sling procedure. 

Other procedures that may be performed 

Stress incontinence often occurs due to prolapse of pelvic organs, such as the bladder, uterus or rectum. Prolapse is a condition in which the organ slips out of its normal place and protrudes into the vagina. Bladder or uterus prolapse can make incontinence problems worse. As a result, your doctor may perform other procedures during your incontinence sling procedure to treat incontinence. 

Other procedures can include:

  • Colporrhaphy treats a prolapsed bladder (cystocele) or rectum (rectocele) by repairing the weakened wall between the vagina and the bladder or rectum. The surgery is performed through the vagina.
  • Hysterectomy treats a prolapsed uterus by removing it. 
  • Uterine suspension treats a prolapsed uterus by shortening stretched-out ligaments that support the uterus. Alternatively, your surgeon may suspend the uterus with mesh attached to the pelvis.
  • Vaginal vault suspension treats a prolapsed vagina by stitching the upper part of the vagina (vaginal vault) to strong ligaments toward the back of the pelvis. Another version, called a sacrocolpopexy, lifts the vaginal vault by supporting it with mesh, which is attached to the pelvis. Vaginal vault suspension can also treat a uterus, bladder, or small bowel that has slipped out of place due to a weakness in the vaginal wall.

Why is an incontinence sling procedure performed?

Your doctor may recommend an incontinence sling procedure to treat stress incontinence. Stress incontinence usually occurs when muscles that support the bladder and hold in urine are weak. It is very common in women who have had children. It is also associated with, or made worse, by the following:

  • Bladder infection
  • Caffeine and alcohol 
  • Coughing, sneezing and laughing
  • Diabetes, which can cause excess urine production and nerve damage
  • High impact or contact sports, such as running, softball and tennis
  • Medications that increase urine production, such as “water pills” (diuretics) 
  • Obesity
  • Smoking

Who performs an incontinence sling procedure?

The following specialists perform the incontinence sling procedure:

  • Obstetrician-gynecologists specialize in women’s 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 women’s pelvic floor disorders.

How is an incontinence sling procedure performed?

Your incontinence sling procedure will be performed in a hospital or surgery clinic. The procedure varies depending on the type of incontinence sling. The sling can be made of tissue from your own body, someone else’s body, or from a synthetic material. The surgery generally involves looping the sling under your urethra to provide support and compress it to control urination. Your surgeon then attaches the sling to strong tissues in your lower abdomen.  

Surgical approaches to an incontinence sling procedure

Your doctor will perform an incontinence sling procedure using one of the following approaches:

  • Minimally invasive incontinence sling procedure uses a laparoscope, which is a thin, lighted instrument with a small camera that transmits pictures of the inside of your body to a video screen. Your surgeon will insert a laparoscope and special instruments through small incisions in the belly and vagina to perform the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make a small incision(s) instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.
  • Open incontinence sling procedure allows your surgeon to directly see and access the inside of your body. Your surgeon will make an incision in your vagina and one or two incisions in your lower belly or in the creases of your thighs. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.