Urology Care Foundation The Official Foundation of the American Urological Association

Urology Care Foundation The Official Foundation of the American Urological Association


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(Also known as Mid-Urethral Mesh Sling Surgery)

Stress Urinary Incontinence (SUI) is a common health problem. People with SUI leak urine when coughing, sneezing, laughing, or doing other physical activities. One treatment for SUI is “sling” surgery. During this surgery, a sling is placed under the urethra, which gives support to help prevent urinary leakage. The sling can be made from one’s own tissue (autologous graft), a donor material (typically skin or fascia), or synthetic (man-made) materials. Synthetic surgical mesh is used in the treatment of a number of health problems, most commonly for hernia repair.

In 2011, the U.S. Food and Drug Administration issued a warning about synthetic surgical mesh when used in vaginal procedures. That warning prompted increased study of the material, especially when used to repair pelvic organ prolapse (POP). POP can be a serious health problem in which some organs (such as your uterus or bladder) descend into the vagina causing a vaginal bulge and typically a sense of pressure or discomfort. The Urology Care Foundation is concerned that there might be confusion about the two different uses of vaginal mesh.

The American Urological Association (AUA) still advises doctors that synthetic mesh slings are a suitable treatment for women with SUI. The AUA points out there is a great deal of data supporting the use of synthetic slings to treat SUI. Adverse effects can result from sling surgery, regardless of the type of sling used. These side effects include difficulty voiding, or even inability to void in rare circumstances. Extrusion of the mesh into the vagina after surgery is something unique to the use of a synthetic mesh, but may be treated effectively in a fairly straightforward manner in most circumstances. The side effects encountered after mesh sling surgery are typically easier to manage than the side effects which can rarely result from vaginal mesh surgery for prolapse conditions. More serious side effects, such as damage to the bladder or urethra are quite uncommon, can occur with any type of sling material, and might require further surgeries.

If you are thinking about sling surgery for SUI, here are some questions you can ask your doctor:

  • What type of mesh will be used? Synthetic, donor tissue, or your own tissue?
  • Why are you suggesting this surgery for me?
  • How many of surgeries have you done with this kind of sling?
  • What kind of training do you have doing this kind of sling surgery?
  • What kind of results can I expect?
  • What side effects have your sling patients had? How often have you seen these side effects?
  • Once I go home from the hospital, are there any symptoms or side effects I let your office know about right away? (Some symptoms, such as bleeding, pain or urinary problems, may be need to be dealt with right away.)
  • Are there other surgeries or treatments that could help me?
  • What are some of the side effects of other surgeries and treatments?
  • What kind of results could I expect with other surgeries and treatments?

For more information:

Visit our It's Time to Talk About SUI page.
Read an article on “Vaginal Mesh for SUI Repair” in our Winter 2014 issue of UrologyHealth extra.
Click here to view the FDA’s statement: “Considerations About Surgical Mesh For SUI.”
Click here to view the AUA statements about the use of mesh to treat SUI and POP.

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