Urethral Sling Melbourne

Mid urethral sling procedures are designed to resolve or improve stress incontinence in women. Stress incontinence is the leakage of urine with everyday activities including walking, coughing, sneezing, lifting or exercise. The severity of stress incontinence varies between person to person.

Stress incontinence is caused by weakening of the muscles and ligaments that normally support the urethra and allow it to close firmly when straining or exercising to prevent urine leakage.

Stress incontinence may improve or resolve with conservative management such as pelvic floor exercises and lifestyle changes. If conservative management has failed, then you may be recommended for a mid-urethral sling procedure.

Mid urethral slings

A mid urethral sling involves placing a polypropylene mesh between the middle portion of the urethra and the skin of the vagina. Placing the mesh underneath the urethra improves the support and reduces or stops the leakage.

The two routes for placing the slings include Retropubic and transobturator.

The Retropubic sling is placed through a small cut made in the vagina over the mod point of the urethra. Through this cut the two ends of the sling is passed from the vagina to either side of the urethra to exit through two small cuts made just above the pubic bone in the hairline. The doctor will then perform a cystoscopy (telescope with a camera) to check the sling is positioned corrected and not sting within the bladder.

What are the risks following this procedure?

• Urinary tract infection – this is not uncommon and you should respond well to antibiotics. Symptoms include: burning, stinging, the need to pass urine more frequently and cloudy and offensive urine.
• Bleeding – Bleeding requiring a blood transfusion is very rare.
• Difficulty passing urine – some women have difficulty passing urine following surgery. This is due to swelling around the urethra or discomfort. This usually settles within a week.
• Sling exposure – the sling can appear in the wall of the vagina a few weeks, a few months or years after the procedure. You may feel an uncomfortable prickling sensation in the vagina. There may also be some blood stained discharge. Please consult with your doctor as your earliest convenience.
• Bladder or urethral perforation – bladder perforation can occur following a retro-pubic procedure and urethral damage following a trans-obturator procedure. Your surgeon will arrange a look inside your bladder via a cystoscopy and will discuss appropriate management for you.
• Urgency and urge incontinence – Women who have stress incontinence often experience these symptoms. Whilst they improve for many following a sling procedure, for 5 % of patients the symptoms may be worse. Further discussion is required with your doctor to discuss appropriate management.
• Pain – long term pain caused by the sling is unusual. For some, this pain may last 1-2 weeks and then usually resolves.

Before surgery

• Ensure your hospital paperwork is completed and sent to the hospital at least 7 days before surgery.
• Ensure you have all your tests completed 4-7 days before surgery. These include bloods and urine test.
• Once admitted, you will be issued with anti-embolic stockings (compression stockings). You are required to wear these throughout your admission.
• If you are a Diabetic, are on any blood thinning medications or have any allergies please alert the nurse at your earliest convenience.
• You will be instructed on how to catheterise intermittently. Sample catheters will be arranged by the Practice Nurse. This is necessary if you have any difficulties passing urine following surgery.

• Following surgery:
• You will have intravenous fluids for 1-2 days. If you are drinking and eating well the intravenous fluids will be stopped.
• Continue to wear your compression stockings.
• You will have a waterproof dressing. This will enable you to shower. This dressing is to remain intact. You are to return to the rooms for a wound review 1 week following surgery.
• You will have a urethral catheter for 1-2 days to allow healing to take place. Once your catheter is removed, nursing staff will monitor how effective how are emptying your bladder.
• You will find emptying your bladder will feel differently as pain in muscles and swelling improves. Take your time to empty your bladder and do not push or strain. If you are emptying well you will be discharged.
• Avoid constipation. Please speak to the nursing staff if you are having difficulties.
• You are advised to take regular pain relief as this will enable you to mobilise gently on the ward.

Following discharge

• You will return to the rooms for a wound check and ultrasound residual one week following surgery. Your wound dressing will be removed and redressed if required. Please empty your bladder when you arrive to the rooms and the nurse will then perform an ultrasound residual using the bladder scanner.
• You will also see your surgeon who will check on your progress.
• You are advised to pass urine normally and not to strain or push to empty urine. Most women will find it is slower to empty following surgery. This will improve as swelling resolves.
• You will need to return to the rooms for your first post-operative appointment 6 weeks after surgery. At this appointment you will also require another ultrasound residual. Please empty your bladder when you arrive to the rooms and the nurse will then perform an ultrasound residual using the bladder scanner.
• It is important you avoid constipation. Please ensure high fibre diet with adequate fluids. If you are having difficulties, please contact the Practice Nurse.
• You are advised to avoid heavy lifting for 6 weeks. Anything greater than 2 kilos is too heavy. This includes taking the bins out and holding shopping bags.
• You are advised to avoid any strenuous physical activity for 6 weeks. This includes bike riding, golf and attendance at a gym. There is a risk of malfunctioning the sling during this 6-week period if strenuous activities are undertaken.
• Abstain from sexual intercourse for 6 weeks until your first appointment following surgery.
• If you have a problem with urge or urge incontinence, you may be advised to see a Continence Physiotherapist for bladder retraining exercises.

You are advised to call the rooms if you develop any of the following symptoms:

• Difficulty or inability to pass urine
• Fever/chills
• Red and inflamed wound, discharge from wound
• Offensive urine,
• Frequency, urgency and burning when trying to pass urine
• Blood in urine