A vaginal/urethral sling is a treatment used to treat stress urinary incontinence (SUI), a medical condition that is underdiagnosed and underreported. SUI is a condition that affects both the young and the elderly.
This surgical procedure is carried out through the vagina and a little cut below the belly button. It’s done under general anesthesia and typically takes around 30 minutes.
During the surgery, a band made of sling material is positioned directly under the bladder neck or the mid-urethra, and it is linked to the robust tissues of the lower abdomen. During physical exercise, the sling functions as a physical support to prevent the organs from slipping and producing pressure and incontinence. During this process, the following steps are carried out by the doctors:
An incision ranging in length from two to four inches is made in the bottom portion of the stomach (abdomen), close to the area where the pubic hairline is located. After that, a second, smaller incision is made on the front vaginal wall.
If it is necessary to use tissue from the patient’s own body for the sling, the tissue is mostly extracted from the patient’s abdomen or thigh. If synthetic materials or donor tissue are utilized, they are sized appropriately.
The surgeon inserts the sling into the bladder and urethra through both incisions. The sling’s ends are attached to strong abdominal tissues.
Sutures, staples, or tape strips are used to close the abdominal incision. Sutures are then used to close the incision made in the vagina.
Pubovaginal Sling Surgery Placement
Stress urine incontinence (SUI) is treated by Pubovaginal sling surgery. A “sling” made of tissue is placed like a hammock directly under the bladder and urethra in this procedure. The sling aids in keeping the urethra and bladder in place. This helps reduce urine leakage by keeping the urethra tight.
The vaginal and suprapubic incisions above the pubic bone are used for the pubovaginal sling surgery. The patients are placed in a dorsal lithotomy posture for this procedure. It entails putting a strip of sling material precisely behind the bladder neck or mid-urethra and attaching it to the strong tissues of the lower abdomen. Patients often undergo a void trial in the healing area after sling installation. Exercises for the pelvic floor are indicated following surgery to prevent urethral blockage. The majority of women typically spend two nights in the hospital after this sort of operation.
Pubovaginal Sling Surgery Complications
The following complications mostly arise in patients who undergo the pubovaginal sling procedure:
- Damage to nerves or blood vessels.
- Fistula.
- Bleeding.
- Trouble Urinating.
- Bowel obstruction
- Damage to the vagina, bladder, or urethra.
- Vaginal exposure to a synthetic substance.
- Infection.
- Blood clots in the lungs and legs.
One of the most frequent problems associated with sling surgery is bladder perforation, which occurs between 1 and 15% of the time. After surgery, minor problems including bleeding, short-term urine retention, and short-term discomfort are often easier to treat. Many years after the treatment, problems including erosion, infection, and vaginal extrusion can arise. Complications from vaginal mesh surgery can also give rise to medicolegal issues. Before performing this operation, patients need to have an in-depth conversation with their primary care physician about all of the potential dangers as well as the various treatment options available for pelvic organ prolapse.
Certain consequences, including organ perforation and erosion, can be more challenging to cure and frequently necessitate further procedures with greater morbidity, while many others, like short-term issues, are simple to manage. Before undergoing this procedure, patients are recommended to have an in-depth talk with their doctor about the risks and alternative treatments for pelvic organ prolapse.
Pubovaginal Sling Surgery Recovery
Patients frequently feel weak and exhausted for several days after surgery. Patients may have pain or cramping in their lower abdomen, and their pubic bone may feel bruised. These symptoms improve in one to two weeks. Patients often experience vaginal bleeding for up to one month. It is typical.
The patients’ urine leakage is reduced or becomes nonexistent when they laugh, sneeze, cough, or exercise. People may first find it more difficult to empty their bladder than usual. This normally improves after one or two weeks.
In one to two weeks, the patient is most likely to be able to resume normal activities, including going to work. Thus, she requires at least six weeks to fully heal before resuming normal activities. Heavy lifting and physical activity are discouraged at this time. They can increase strain on the bladder as the body heals.