Bladder Sling

Bladder Sling


You may already be aware of what a bladder sling is if you are a woman who suffers from urinary incontinence. The most common type of sling procedure done is the TOT sling, also known as a transobturator tape sling.  Another common bladder sling procedure is the TVT sling, which is also known as a tension-free vaginal tape sling. The TVT sling is a common surgical solution to female urinary incontinence. These procedures have eliminated almost every other solution for urinary incontinence available.

How it Works

Bladder sling surgery involves placing a supportive sling around the back of the urethra to help lift it back into a normal position. When the muscles become weak under the urethra, it can allow the seal to become weak at moments of excessive strain, such as a sneeze or cough. The sling is inserted through incisions in the thighs and is held in place by the abdominal wall.

Bladder sling surgery is a convenient, 30 minute outpatient procedure that has a success rate of about 90%. The incisions used during this type of surgery are extremely small, usually less than one centimeter. This makes the recovery period less than one week for most bladder sling surgeries.
Before deciding on a doctor to use for a bladder sling surgery, you should probably ask them a few questions. The first question to ask how much success the doctor has had performing this surgical procedure. Most bladder sling surgeries have less than a 10% chance of failure, but this will depend highly on the amount of experience your surgeon has in performing this procedure. The next thing you will definitely want to ask is if there is anything at all that you can do before the surgery to increase the chance for success. There are a few things you can do to help increase your odds of a successful outcome which include not smoking, and doing kegel exercises prior to the surgery.

Bladder Slings

The most popular form of bladder sling surgery uses pieces of your own body’s tissue or other synthetic materials such as a mesh to create a hammock like support around your bladder and urethra. The sling provides the support necessary to keep the urethra sealed, especially during times when you sneeze or cough. Most slings boast a high rate of success and a low risk of facing any complications.
The solution of using your own tissue to bind the sling can eliminate some problems with rejection, but it also leaves you vulnerable to the risk of wearing away the tissue of the urethra or even the vagina. Using your own tissue also increases the amount of time the surgery takes and also increases the number of incisions required, as the tissue must be taken from the body. This can increase the risk of infection substantially.
Tension free slings are made from a strip of synthetic mesh that is infused into your abdominal wall. Instead of using stitches, scar tissues form around the mesh to keep it held in place securely. Erosion and other serious complications have been known to occur with this type of sling, though they are rare.

Adjustable slings are another popular choice among bladder slings. These slings can be adjusted for tensions during and after the procedure. When the person awakes from surgery, the doctor is able to work with them to adjust the sling to the proper tension necessary to eliminate their urinary incontinence.
Conventional sling are inserted through a vaginal incision and wrapped around the back side of the bladder. They may be made from natural tissues or synthetic materials. With a traditional sling, stitches are used to bind the sling to the abdominal wall to achieve the correct amount of tension. Conventional slings may require a larger incision which can lead to longer stays in the hospital during recovery. Conventional bladder slings are somewhat deprecated and have been largely replaced by tension free slings.

Bladder Sling Surgery

A bladder sling surgery is typically performed by making two small incisions, less than a centimeter each, at the inner thigh. Theses incisions are made at the suburetheral and miduretheral levels. The incisions are used to provide a way to insert the bladder sling into place.
Bladder sling surgery is always performed under general anesthesia or IV drip sedation. The first thing anesthesiologists do is to inject a local anesthetic directly below the urethra. Then a small one centimeter incision is made suburetherally at a miduretheral level. This dissection is carried out to the pubic arch bilaterally. To be more specific, the dissection is brought toward the anterior obturator notch which is found in the obturator foramen.
Next, the inner thigh incisions made earlier on the left and right side are both injected with a local anesthetic. Another small one centimeter incision is made in the thigh, at the same level as the clitoris, which is about 2 centimeters below the adductor longus tendon that runs bilaterally.
A bladder sling is typically made from a polypropylene tape, though sometimes it can be made from living tissue. The bladder sling is attached to tips of a helical introducer. The sling is then placed into the suburetheral incision that was made at the midurethral level. The next step of the procedure is the most important, adjusting the bladder sling. Doctors will place a surgical instrument between the sling and the bladder to ensure that it isn’t set too tight.

Extreme Bladder Issues

If you suffer from more extreme incontinence, the sling will typically be placed a little bit tighter to give your bladder the extra support that it needs. If your incontinence is less severe, Doctors will often times leave the sling quite a bit looser. This is why finding a Doctor who is experience in bladder sling surgery is extremely important. Getting the sling to just the right tension can be the difference between success and failure. If the sling is too tight, it’s possible you won’t be able to empty your bladder completely. If the sling is placed too loosely, you will continue to suffer from urinary incontinence after surgery.
After the tension has been set for your bladder sling, the extra material is cut away bilaterally and the incisions on the inner thigh are closed with a substance that’s comparable to human super glue, called Dermabond. Dermabond is an incredible innovation in healing. It seals wounds and keeps them waterproof to prevent any infection at the incision site, especially when bathing or swimming. Finally, the suburethral incision is closed using dissolvable sutures, and the surgery is complete.

Bladder Sling Surgery Recovery

Recovery from a bladder sling surgery is much less severe than recovering from other major medical procedures like heart surgery. The minimal invasiveness of the surgery means there’s much less to heal afterwards. The small incisions will heal quickly and you’ll be back on your feet before you know it.
Most bladder sling surgeries are completed in as little as 30 minutes, which makes them ideal for busy people. The recovery period for most people is less than a week, though it all depends on how healthy you are when you have the surgery done. The quick recovery time makes bladder sling surgery an attractive option for anyone who suffers from urinary incontinence.

Limitations

The first major limitation you will face when recovering from bladder sling surgery is that you can’t do any heavy lifting. For some people this may be a welcome relief, but it can be a major impairment for someone who performs manual labor for a living. You should wait a full three months before performing any heavy lifting after a bladder sling surgery. It takes the body a long time to regenerate tissue that grows into the mesh sling, making it strong. This limitation is typical for any type of hernia surgery.
The second limitation you need to be aware of is keeping your wounds from surgery clean and dry for at least two full months. This means you should only be taking a shower, and not a bath. This also means no hot tubs, or pools either. It will take six to eight weeks for the dissolvable sutures to dissolve completely. You should clean your sutures daily and apply a product like Neosporin to help your wounds heal completely, without infection.
The third limitation you may not like as much. The first two were bad, but this one can be a major bummer for most women. You aren’t allowed to have sexual intercourse for a full two months following a bladder sling surgery. You must allow the sling to heal completely before engaging in sex. This may be difficult for most people to do, but it’s absolutely necessary in ensuring a healthy recovery from surgery.

Bladder Sling Complications

Unfortunately, bladder sling complications may be a reality for some recipients of this surgery. No surgery is ever 100% guaranteed, so you must be aware of what may go wrong during or after bladder sling surgery before deciding to undergo it yourself. Bladder sling surgery is about 90% successful for most people, so you stand a good chance to experience no complications at all, but there are still things you need to know.
The anesthesia that’s used for a bladder sling procedure can carry some risks of forming a blood clot. It’s not uncommon for women to experience the development of blood clots in their lungs, legs or other parts of the body following surgery. It’s important to know the warning signs so you can seek help if you experience blood clot after surgery. The symptoms include trouble breathing and a shortness of breath. If you have developed a clot in your leg, often times you will feel pain and pressure in your calf. There will also be swelling and redness around the affected areas.
Bladder sling surgery may cause swelling of the vaginal and urethral tissue associated with the various instruments used to perform the surgery. This swelling can sometimes lead to urinary retention following the surgery, which is the inability to urinate at all. Urinary retention may be a short term side effect of bladder sling surgery, though if it continues; it may require a catheter to empty your bladder properly until you resume urinating regularly. If urinary retention still exists after a longer period of time, you may actually have to have your bladder sling removed or readjusted.
Some women have also reported spasms located in the bladder after receiving their bladder sling placement. The muscles in the bladder can become irritated during the surgery and tend to contract and relax in waves. Although these spasms are generally nothing to worry about, they may cause leakage of your bladder and cause you to feel some pain. Most women only experience bladder spasms for a short period of time, though some may actually experience bladder spasms long term as a result of the surgery.

Like with any other surgery, bacterial infection is always a risk. Bacteria may inadvertently enter the urinary tract during surgery. This may cause you to get a UTI, also known as a urinary tract infection. Bacteria may also be introduced to the bladder when catheters are used to drain the liquid. It’s painfully obvious when you contract a urinary tract infection as you will likely experience a burning pain when urinating or may even notice some blood mixed with your urine.
A urinary tract infection isn’t the only bacterial infection you may face though when undergoing a bladder sling surgery. You may also be at risk for developing infections in any of the incisions used to place the bladder sling. Symptoms of infection might include pain near the incisions or abdominal pain. You may also experience a foul smelling discharge directly from the vagina if infection exists. Infection has been known to set in on the graft tissue used to suspend the bladder sling and could result in abdominal pain, fever, or worse.

Bladder Sling Conclusions

A bladder sling is a surgical procedure that’s more complex than other methods used to correct stress incontinence which makes it a greater risk of damaging the urethra. A bladder sling will typically be used when other surgeries for incontinence have already failed. You must be aware of all the risks involved as well as the benefits when considering bladder sling surgery.

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