Stress urinary incontinence is a common problem in women after childbearing and worsens with age. Effective conservative therapy is available however in severe cases surgery is the only option for a cure. The mid-urethra sling has become the standard for surgical correct of stress urinary incontinence. The majority of women who undergo the sling procedure are satisfied with their outcomes but complications can occur and if managed appropriately can have minimal long-term effects.

The retropubic mid-urethra sling, also called the tension free tape (TVT) was the first in this class. They all use a polypropylene mesh strip which is incorporated into the peri-urethra tissue. In theory, this should provide a permanent fix of the problem. The cure rates for this sling is reported at 85-92% at 5 years and this is excellent. Issues associated with this sling include a 34% urinary tract infection rate at 3 months, a reported voiding dysfunction (incomplete or difficult voiding) rate of 20-47%, and 25% risk of urinary urgency. Other more severe complications include bladder injury up to 7%, mesh erosion as high as 2.5% and inability to void at 3 months at 3%. Rare but serious complications also occur and include intestinal and vascular injury requiring blood transfusion, additional surgery, and even death.

The transobturator mid-urethra sling was developed in an attempt to avoid the more serious complications seen in the retropubic mid-urethra sling. Its insertion site is farther away from the bladder and the vital organs of the pelvis. The cure rates are reported 73-81% while the risk of voiding dysfunction is significantly lower at less than 11%. The urinary tract infection (6.4%) and bladder injury rates (less 1%) are also much less. The mesh erosion rate is about the same while there is a much higher rate of groin/leg pain which occurs in 12-16% of the cases. As with the retropubic sling the incidence of vascular and intestinal injuries are rare.

The single incision slings, also called mini-slings were developed in an attempt to make the procedure even easier and with less complications. The amount of mesh used is less and only a single incision is required to insert the sling. The procedure can even be performed in the office setting with local anesthesia. This is a relatively new procedure so long term data about effectiveness is limited. The 12 month data suggests a cure rate of about 76% with voiding dysfunction occurring less than 10% of the time. The rate of mesh extrusion/exposure is about the same as the other slings.

Each sling has its pros and cons. The ideal situation is to select the most appropriate procedure which will minimize the risk of complications but maximize the chance of success. This is where an experienced surgeon comes in handy. It is easy to decide to do the surgery and it is just as easy to perform any of these procedures. The key is to have a provider who selects the right procedure the first time and who is able to manage any complication that may arise. Sling outcomes can be unpredictable and it is best to choose a surgeon who has the proper training and experience.

I hope this article has provided you with information that will help you make wise choices, so you may:

Live healthy, live well and live long!