Transvaginal mid-urethral sling for urinary incontinence

Specialist:
Huann-Cheng Horng
Yi-Jen Chen
Chia-Pei Chang
Wei-Ting Chao

Feature Summary

Transvaginal mid-urethral sling procedures are performed to treat stress urinary incontinence. Before proceeding to surgery, your doctor will discuss alternative options, such as bladder training, Kegel exercises, medications, etc. Surgery may be the best option if these measures fail to alleviate your symptoms.

Overview

You may have stress urinary incontinence if you experience leakage while laughing, coughing, sneezing, jogging, or lifting heavy objects. This is a common bladder control problem among elderly women. The condition occurs when the muscles and tissues surrounding the mid-urethra become weak, causing the sphincter muscles to briefly open and resulting in leakage when there is increased pressure on the bladder or mid-urethra. Risk factors for stress urinary incontinence include weight gain, sports injuries, or vaginal childbirth.

Features

The gold standard for treating stress urinary incontinence is a mid-urethral sling or Tension-Free Vaginal Tape (TVT). The polypropylene sling is placed around the urethra without tension, providing support to the urethra during increased abdominal pressure. The success rate for patients without prior incontinence surgery is over 90%. For those with prior incontinence surgery, the success rate may vary. Traditional TVT requires two 1 cm suprapubic incisions and has a higher risk of bladder perforation and voiding difficulties. The new "mini-sling" has a similar success rate and high patient satisfaction, with a lower rate of complications. Our data on the mini-sling has been published in an international journal.

Procedure

The surgery is performed under general or intravenous anesthesia, during which you will be unconscious and feel no pain. A foley catheter will be inserted into your bladder to drain urine. The doctor will make a small incision inside your vagina, where most of the procedure will be performed. The sling, made of synthetic material, will be passed under your urethra and bladder neck, and attached to the strong tissues in your lower abdomen. The traditional transvaginal mid-urethral sling requires two small incisions on both sides of the inguinal area or supra-pubic region. For the self-pay mini-sling, there will be no incisions in the perineum, supra-pubic region, or inguinal area.

Notification

Risks and Complications

• Difficulty emptying the bladder and need for a catheter (3.3%)

• Erosion of synthetic material into normal tissue (2%)

• Damage to the urethra, bladder, or vagina (<1%)

• Abnormal passage (fistula) between the vagina and skin (<1%)

• Irritable bladder, leading to frequent urination (5%)

• Worsening of urine leakage (5%)