What is Urethral Vaginal Sling

Urethral vaginal sling procedure is surgery to correct urinary incontinence. Urinary incontinence is passing urine without one’s control. It is common in older women, and in women who have had children. In this surgery, a strong piece of material is placed under the tube that drains the bladder (urethra). This sling is made of tension-free vaginal tape or nylon mesh. It fits under the urethra like a hammock. The sling is put in position to straighten, support, and hold the urethra in its normal position.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Excessive bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Problems urinating for several days or weeks.
• Return of the urinary incontinence.
• Mesh failure. Be sure to talk with your health care provider about the options you have for sling material and the risks associated with each material.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• You may be given antibiotic medicine to help prevent infection.

General instructions

• Ask your health care provider how your surgical site will be marked or identified.
• You may be asked to shower with a germ-killing soap.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes, for 2 weeks before the surgery. If you need help quitting, ask your health care provider.
• Plan to have someone take you home from the hospital or clinic.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your skin will be washed with soap.
• An IV will be inserted into one of your veins.
• You will be given one or both of the following:
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).
• A catheter will be placed in your bladder to drain urine during the procedure.
• An incision will be made in your vagina and on the lower part of your abdomen.
• The sling material will be passed around your bladder neck and stitched (sutured) to the muscles to hold the urethra in its normal position.
• The incisions will then be closed with sutures.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will have a catheter in place to drain your bladder. This will stay in place until your bladder is working properly on its own.
• You may have a gauze packing in the vagina to prevent bleeding. This will be removed in 1–2 days.

Summary

• A urethral vaginal sling procedure is surgery to correct urinary incontinence.
• In this surgery, a strong piece of material is placed under the urethra to hold it in its normal position.
• Follow instructions from your health care provider about eating and drinking before the procedure.
• After surgery, you will have a urinary catheter in place until your bladder works properly on its own again.

Urethral Vaginal Sling, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure:

• It is common to have some abdominal pain. Your health care provider will give you pain medicines for this.
• You may also have a gauze packing in the vagina to prevent bleeding. This will be removed in 1–2 days.

Follow these instructions at home:

Incision care

• Follow instructions from your health care provider about how to take care of your abdominal incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

• Get plenty of rest.
• Limit exercise and activities as told by your health care provider.
• Do not lift anything that is heavier than 5 pounds (2.3 kg) until your health care provider says that it is safe.
• Do not douche, use tampons, or have sexual intercourse for 6 weeks after your procedure or as told by your health care provider.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

General instructions

• If you have a urinary catheter in place, follow instructions from your health care provider about how to empty the catheter bag.
• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.
• Take over-the-counter and prescription medicines only as told by your health care provider. Do not take aspirin because it can cause bleeding.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
• You may resume your usual diet. Eat a well-balanced diet.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Avoid straining when having a bowel movement.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a heavy or bad smelling vaginal discharge.
• You have bruising in the vaginal area.
• You have pain that is not controlled with medicines.
• Your incision feels warm to the touch.
• You have redness, swelling, or pain around your incision.
• You have pus or a bad smell coming from your incision.
• You have fluid or blood coming from your incision.
• You feel faint or light-headed.
• You have a rash.

Get help right away if:

• You have a fever.
• You faint.
• You have shortness of breath.
• You have chest, abdominal, or leg pain.
• You have pain when urinating or cannot urinate.
• Your catheter is still in your bladder and it becomes blocked.
• You have vaginal bleeding.
• You have swelling, redness, and pain in the vaginal area.

Summary

• After the procedure, it is common to have some abdominal pain. Your health care provider will give you pain medicines for this.
• Follow instructions from your health care provider about how to take care of your incision.
• Limit exercise and activities as told by your health care provider.
• Contact your health care provider if you have any signs of infection after your surgery.