Why is it done?

• Stress urinary incontinence.
• A combination of stress incontinence and lesser degree of detrusor overactivity – mixed incontinence.
• Involuntary urine leakage with any exertion, coughing or sneezing.
• Risk factors:
  • More than 2 pregnancies, big babies.
  • Complicated deliveries, episiotomy.
  • Smokers.
  • Being overweight.
  • Diabetes
• Where Intrinsic Sphincter Deficiency has been proved due to a failed previous sling.

How is it done?

• This procedure is done under a spinal / general anesthetic, as decided by the anesthetist.

• The legs will be elevated into the lithotomy position.
• A small incision is made in the vagina. The sling is placed behind the pubic bone and brought to the skin above the pubic bone, with a small incision.
• A synthetic mesh is used after in detail consultation with yourself
• This will be used as a last resort
• You will be made aware of the TGA mesh withdrawal in Australia and Europe – especially involving mesh used for vaginal prolapse surgery
• The sling is placed tension free.
• If you have a suspected Intrinsic Sphincter Deficiency (ISD), the sling may be placed tighter.
• The bladder will be inspected with a Cystoscopy to exclude any injuries to the bladder wall.
• The wounds are closed with dissolvable sutures and/or skin glue.
• A local anesthetic is given for pain relief.
• A urinary catheter is placed for 24hrs.
• A vaginal plug will also be placed.
• The catheter and plug will be removed early the next morning.
• The patient’s urine output will be measured each time they urinate, and the residual will be measured. (Patients will be required to do this up to 3 times).
• If the residual amount of urine is more than 250-300 cc, the patient may have to self-catheterize, until the residual volume is acceptable.
• Prophylactic antibiotics will be given to prevent infection.

What to expect after the procedure?

• Any anesthetic has its risks, and the anesthetist will explain all such risks.
• Complications:
  • hemorrhaging, requiring blood transfusion <1%.
  • bladder perforation, requiring an open repair <1%.
• Patients will wake up with a catheter in the urethra and bladder. This will remain in the bladder for 24 hrs.
• Above pubic bone area discomfort/pain will persist for a few days, but this will subside or settle.
• If you cannot urinate after 2-3 attempts, the sling may be readjusted.
• You may be required to self catheterize for a week or two.
• If there is no improvement the sling may be cut, to allow spontaneous urination.
• NB! Each person is unique and for this reason symptoms may vary!

What next?

• Patients will have a trial of void without catheter the next day.
• Patients will be discharged as soon as they can completely empty the bladder.
• Patients may be required to self-catheterize for a week or two.
• Patients may initially suffer from urge incontinence and frequency, but this will improve within the next 6 weeks.
• Your flow will be slower.
• Allow 6 weeks for symptoms to stabilize.
• There may be some blood in the urine. This can be remedied by drinking plenty of fluids until it clears.
• On discharge a prescription may be issued for patients to collect.
• Patients are to schedule a follow-up appointment in 6 weeks.
• Please direct all queries to Dr Schoeman’s rooms.
• PLEASE CONTACT THE HOPSITAL DIRECT WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.

Remember to discuss mesh and its complications with Jo. This is used as a last resort, and you should be aware of the risks!

Download Information Sheet

Wes Mid-urethral Retropubic sling