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Female Sling - Synthetic Slings


Stress incontinence is urinary leakage that occurs with exercise, coughing, sneezing or laughing. This type of leakage is very reliably treated with pubovaginal sling surgery with complete success rates approaching 90%.


You will have seen in newspapers and the internet that there is a lot of controversy about "mesh". Synthetic slings have been used to treat stress incontinence for 20 years with excellent results. The medical evidence and our own results over the last 15 years support their ongoing use. There are risks associated with synthetic sling surgery, and these risks are minimised with detailed and accurate pre-op investigation. Recent and ongoing directives from the Ministry of Health have clarified that synthetic slings are safe to use. They have identified that mesh for pelvic organ prolapse (eg a bladder prolapse or cystoscoele) are not safe, and cannot be used in New Zealand. We have never used this mesh for prolapse.


There are good alternatives to a synthetic sling. This includes using your own tissues (the lining of your abdominal muscle, rectus fascia). This takes longer, and has a slower recovery, but the long term outcomes are good. 

This decision making tool can be helpful to clarify all the issues.


It is important to take your time and consider your options, More information is available here.

See also the Ministry of Health document on Synthetic Slings.


Procedure- Synthetic Pubovaginal Sling
You will be admitted to the hospital on the day of surgery. A urine test will have been done beforehand to ensure there is no active urine infection.

This procedure is usually done under general anaesthesia and takes around 30 minutes.
Three incisions are required to insert the sling. Two small incisions are made in the lowest part of your abdomen just above your pubic bone and a 3 cm incision is made in the front wall of your vagina. Trocars are passed from the pubic incisions down to the vagina, an inspection is made of the bladder to ensure that there has been no injury and the sling, which is a polypropylene material, is placed around the mid part of the urethra to give it support. The vagina wound is sewn up with dissolvable sutures, the small suprapubic incisions need only steristrips. A catheter is placed at the end of the procedure.
After your procedure, you will wake up in the recovery ward, and after about half an hour will be transferred up to your room.
You will be able to eat and drink.
You will need to stay the night in hospital. The catheter is removed first thing in the morning, and once you have passed good volumes of urine you are able to go home.
Although it is not a particularly painful procedure you will need regular paracetamol and anti-inflammatories. Occasionally stronger pain relief is required.
You will be seen by Judy Kelly our continence nurse while still in hospital. Judy will keep an eye on you upon your discharge from hospital and is the 1st point of contact if you should have any concerns.
What are the risks of this procedure?
All surgical procedures are associated with some risk. General risks include that of wound infection, blood clot formation and pneumonia but in practice these are rare.
The specific risks relating to sling surgery are outlined below

Bladder Instability
Approximately 20% of women will develop urinary frequency and urgency after the procedure. This feels like a minor urine infection and is the response of the bladder reacting to having to do some work against the sling in order to empty. It can last for 4 to 6 weeks. Most women find this tolerable but occasionally medication is required in order to settle the bladder down.

Urinary Retention
Approximately 10% of women do not pass urine immediately after the catheter is removed. This is again almost always temporary and often resolves after 48 to 72 hours. In a very small proportion of women the return of spontaneous voiding takes longer (weeks) and they will need to be taught how to self-catheterise (pass a catheter into the bladder to empty), but it is rare for this to be longer then 2 or 3 weeks. Less than 1% of women have long-term problems with passing urine.

Bladder Injury
Injury to the bladder may occur with passage of the sling trocars and a cystoscopy is done in order to detect this. In practice this occurs in less than 1% of patients and all that is required is that the sling trocars are repositioned, and then the sling surgery continues as normal. The catheter may be left in for an extra day or two.

Failure of the Sling to Work
There is a small chance that the sling does not work at all. This occurs less than 10% of women. With time (usually many years), there is a small risk that your incontinence returns. This is usually due to weakening of tissues around the sling, and very occasionally a second sling is required.

Return to Work
It will take about 4 to 6 weeks for the sling to “bed in” and it is very important that you avoid exertion and exercise over this time. Depending on your occupation you may be able to return to work about one week after your procedure. Sexual intercourse may resume when you are comfortable, this is usually about 4 weeks post-operatively.
Judy Kelly, Continence Nurse Specialist, will have seen you prior to being discharged from hospital, and she will keep in touch about your progress. We will arrange a follow up appointment at Bay Urology about 6 weeks after surgery.


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