Bladder Sling Procedures

What you should know

• A bladder sling procedure is done to treat women who have urinary incontinence. Urinary incontinence occurs when urine leaks out of your bladder. Your bladder is an organ at the bottom of your abdomen (stomach) where urine is stored. Urine leaves your bladder through a tube called your urethra. Strong muscles around your urethra keep urine from leaking out. If these muscles weaken, you may have trouble controlling your urine flow. Urine leakage occurs most often when you cough, sneeze, laugh, or lift objects.
  
  
• A bladder sling procedure may be done through a cut in your vagina only. The procedure may also need to be done through a cut in your abdomen and vagina. A strip of body tissue is used as a sling to hold your urethra in place and make it stronger. Part of the thick covering of your abdominal muscles may be used for your sling. Your sling also may be made from a strip of your vaginal tissue, donor (another person) body tissue, or man-made. The sling helps keep your urethra closed even when your bladder is full. Having a bladder sling procedure may help you control your urination. The bladder sling procedure may decrease or resolve your urinary incontinence.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• You may have an allergic response to the anesthesia medicine used during your procedure. During the procedure, your bladder or bowel may be injured. After the procedure, you may have pain, nausea (upset stomach), vomiting (throwing up), bleeding, or bruising. You may get a wound infection or a urinary tract infection. You may have trouble urinating, or you may leak urine. You also may have pain during, or after having sex. The tissue used for your sling may break down, and you may need another procedure to fix it.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• Without the procedure, the muscles and tissues in your urinary tract may continue to weaken. Your symptoms, such as leaking urine, may get worse. You may have more trouble controlling when you urinate. Talk to your caregiver if you have questions or concerns about your procedure, condition, or care.

Getting Ready

Before your procedure:

• Bring your medicine bottles or a list of all your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine, or if you are taking herbs or vitamins. Your caregiver will tell you if you need to stop any of your medicines before your procedure.
  
  
• Your caregiver will ask about any health problems you may have. Tell your caregiver how many times you have been pregnant and given birth. Your caregiver may do a vaginal exam to check for any problems.
  
  
• Tell your caregiver if you have had surgery or radiation treatment on your lower abdomen or vagina. Tell your caregiver if you cough a lot, or if you smoke. You also will need to tell your caregiver if you have problems with your bowels, such as constipation (hard, dry stools).
  
  
• You may be asked to keep a bladder diary for a few days before your procedure. You will need to write down when you urinate during the day, and at night. Also write down when you leak urine, or when you feel your bladder does not empty completely.
  
  
• Tell your caregiver if you have symptoms such as weakness, double vision, or tremors (shaking). Also tell your caregiver if you have a burning or tingling feeling in your skin.
  
  
• You may need to have urine and blood tests done. You may need to have a cystoscopy so your caregiver can look inside your bladder. Your caregiver may also do a cotton swab test to check the movement of your urethra. These tests may help your caregiver plan your procedure and treatment. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your procedure:

• Ask caregivers about directions for eating and drinking.
  
  

The day of your procedure:

• Write down the correct date, time, and location of your procedure.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.

Treatment

What will happen:

• You will be taken to the room where your procedure will be done. You will get medicine that will keep you free from pain during the procedure. If your bladder sling will be inserted through your abdomen, an incision (cut) will be made in your lower abdomen. Part of the thick covering of your abdominal muscles may be used to make your sling. Another small cut will be made in your vaginal wall to insert the sling in the proper area. The sling will be placed under your urethra and around the area where your bladder and urethra meet. One end of the sling will then be on each side of your urethra. The ends of the sling may be stitched to your abdominal wall or screwed into your pelvic bone. When the sling is secured, your cuts will be closed with stitches.
  
  
• If your procedure will be done through your vagina only, a small cut will be made in your vaginal wall. Your caregiver may use a special tool to keep your vagina open during the procedure. Small pins or screws may be placed in your pelvic bone to hold your sling in place. The sling will be inserted through the cut in your vaginal wall. The sling will be placed around your urethra and each end will be attached to your pelvic bone. Once the sling is secured in place, your cut will be closed with stitches.
  
  
• Once your bladder sling is in place, it will hold and support your urethra and bladder. Your caregiver may use a special scope to check inside your urethra and bladder. The scope will show if the sling is in its proper place, and if your urine flow is blocked. A bandage with antibiotic medicine may be put inside your vagina to prevent infection. Your wound (surgery site) is covered with a bandage to keep it clean and dry, and to prevent infection.

After your procedure:

You will be taken to a room where you can rest until you are awake. Do not get out of bed until your caregiver says it is okay. Caregivers will watch you closely for any problems. Your caregiver will make sure you are urinating without problems. You may need to wear special boots or stockings to prevent blood clots in your legs. These will be removed when you start walking after your procedure. If you are staying in the hospital, you will be taken back to your room. The bandage in your vagina may be removed the day after your procedure.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your procedure.
  
  
• You have a fever (high body temperature).

Seek Care Immediately if

• You have sudden trouble urinating.
  
  

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.