Tension-free slings
A tension-free sling is a mesh usually made from a synthetic material called polypropylene. To support the urethra, the sling functions like a hammock and is held in place by body tissues rather than stitches. During the healing process, scar tissue forms in and around the mesh to keep it from moving.
For a tension-free sling procedure, your surgeon will likely recommend one of these approaches:
- Retropubic procedure. The surgeon makes a small cut (incision) inside the vagina to have access to the urethra. There are also two small incisions above the pubic bone, just to the right and left of the center. The surgeon uses a needle to pass each end of the sling from the vagina to abdomen. The sling is held in place by the soft tissue along its path. Absorbable stitches close the vaginal incision, and the incisions on the skin may be sealed with glue or stitches.
- Transobturator procedure. The surgeon makes a small incision in the vagina and small incisions in the right and left groin. The surgical process is similar to the retropubic approach, but the mesh passes through the groin muscles rather than the abdominal wall.
Both sling procedures are safe and effective. But the transobturator sling may not work as well if you also need other procedures to fix pelvic floor problems.
Another tension-free sling is the single-incision mini procedure. The surgeon makes a single small cut in the vagina. A small mesh hammock is suspended from tissues the pelvic region. The surgeon takes care to avoid the groin muscles. The results of the single-incision mini procedure are generally less effective. More research is needed to determine the safety and effectiveness of this method.
Conventional slings
A conventional sling uses tissue from your own body to support the bladder neck. The surgeon collects the tissue to make the sling from either your abdomen or thigh. The surgeon then makes an incision in the vagina to place the sling below the urethra at the bladder neck. From an incision in the abdomen, the surgeon stitches each end of the sling to the abdominal wall.
A conventional sling typically requires a larger incision than a tension-free sling. You might need an overnight stay in a hospital and usually a longer recovery period. You may also need a temporary catheter after surgery while you heal.
This procedure is associated with a higher risk of difficulty emptying the bladder. Therefore, it's typically reserved for women who have had another incontinence procedure but still experience urinary incontinence.