Friday, March 6, 2009

Slings: what are the risks, benefits and recovery?


Mid-urethral slings have become the most common method to treat stress urinary incontinence (SUI). They are typically placed in under 30 minutes in an outpatient setting and are popular with both physician and patients due to the high cure rate, relative ease of placement, low complication rate and quick recovery.

The prototype of modern day slings is the TVT (tension-free vaginal tape), and many similar ones exist on the market that are placed in a similar fashion, but ultimately perform the same function. TVT has been around for approximately 15 years and is used worldwide.
The sling is made of a thin strip of polypropylene mesh weave, a common and safe type of mesh used for surgery in a variety of body locations. The width is 1 cm and the length left in the body is usually between 6-8 inches long. There are various methods for placing slings, but ultimately, it must rest under the mid-urethra.

It is placed through a small incision in the vagina, usually under general anesthesia, and women can go home the same day without a urinary catheter after urinating in recovery. Vaginal stitches to close the skin dissolve, but the sling is permanent. It becomes incorporated into the body tissue. The body lays new collagen and scar within the sling and around it, and it becomes a new firm ligament under the urethra replacing the one that had become weak. The sling acts like a backboard and supports the urethra during straining maneuvers such as coughing, sneezing, laughing, jumping and exercise. It prevents it from descending, thereby preventing urine loss.

Slings are durable to about 10-15 years but longer term data does not exist simply because it hasn’t been around that long. It is less invasive than the next most popular procedure for SUI, the Burch colposuspension, which requires a bikini line abdominal incision and then the bladder neck is raised up and stitched close to the back part of the pubic bone. Despite equivalent cure rates, surgery time and recovery time is longer. It has generally fallen out of favor as a modern approach to curing SUI. If a woman is undergoing other pelvic surgery such as a hysterectomy or bladder lift (cystocele), a sling can be done concomitantly and adds only a few extra minutes to these procedures.

For those women who desire cosmetic vaginal surgery, sling surgery can be done as well at the same time.

The expected cure rate for slings is approximately 89-91% where the female patient is dry. There is about a 2% failure rate, and the rest can be considered improved. Improvement from soaking 6 pads a day to 2 thin liners is a success for severe cases of incontinence.
Durability is important and most (85%) will still be dry in the long term. There is an expected drop off (recurrence) rate which is inevitable given changes that occur to the body with age, menopause, weight loss or gain, etc. Women who are still considering another pregnancy should not undergo a sling till childbearing is complete.

Preoperative evaluation with a history, physical exam, urinalysis, and urodynamics help to make the appropriate decision as to whether: 1. A sling is appropriate and, 2. which type of sling to use. Other factors taken into consideration when deciding if/when/and how to place the sling include age, prior surgeries, body habitus, overall health, and other considerations. Bladder function, capacity, and sphincter function as determined by urodynamics helps to tailor the sling to the individual patient.

Common risks include: infection (low), bleeding (low), injury to bladder (low), mesh exposure in the vagina (low), and post operative urinary dysfunction. Vaginal spotting is expected for 1-2 weeks after the surgery.

Recovery is usually straightforward. Typically, being a “couch potato” for 72 hrs is recommended. Women can return to work thereafter (if non-physical). Exercise and exertion should be delayed about 2-3 weeks, but no pools, baths or sex for six weeks.
Slings will usually work right away even though most scarring isn’t complete for several months. In the first several weeks, occasionally the stream may seem a little slower than usual, or may split or deflect. These usually self correct after a few weeks.

There are women who experience leakage of urine with penetration during sex, and others who experience leakage of urine with orgasm. Several studies have shown that penetration-related leakage is treatable with TVT type slings. Orgasm-related leakage can be treated with overactive bladder medication, but one study did show TVT to help this as well. Urodynamic evaluation is important to verify the correct type of sex-related incontinence prior to treatment.


Despite the fact that TVT and other slings are placed in the vagina under the urethra, it has an overall beneficial effect on female sexual dysfunction when it is related to incontinence. Women may be embarrassed to have sex if they fear a urine leak or odor, and will avoid it or have decreased pleasure. Surgical correction of SUI with TVT has been shown to improve sexual function domains such as desire, arousal, lubrication, orgasm, satisfaction, and pain. As a result of the surgery, women report reacquiring self confidence and greater sexual interest after resolution of sex-related incontinence. The consensus in the literature concludes that there is a positive, not negative, impact on female sexual health.
Most women are motivated to cure SUI and will often first perform Kegel muscle exercises and restrict fluids, or urinate frequently to keep the bladder empty and avoid a leak. These can be successful strategies but are tedious and frustrating to many. Once these conservative options have been exhausted, evaluation for a sling can be performed.

76 comments:

Dennis said...

My wife just had this procedure a week ago and she has run into complications. She is having difficulty completely emptying her bladder to a point where we have had to go to ER to get a catheter. she went from one extreme to another. After a couple days catheter was removed and same thing happening. I am going to take her in again this morning.

Sherry said...

I had a TVT 3 weeks ago today and continue to have quite a bit of pain and discomfort. When I relax to have a bowel movement or to urinate, the pain is sharp and cramping. At rest, the pain is a dull soreness. I find myself walking slightly bent forward because it helps reduce the pain somewhat. I just can't believe this is normal at this point. Fortunately, I have not had problems with urination, but from what I've read, it is not normal to be having this severe of pain at 3 weeks out. Any thoughts?

Matthew E. Karlovsky, M.D. said...

Dennis- It may be that the sling was placed too snug. Sometimes it simply takes the bladder a little while to accomodate to the surgery and swelling, but she may be to self-catheterize the bladder to "exercise" it. Discuss all scenerios with the uro or gyno.

Sherry- It may be that the sling is scarring in too snug, and is pulling. After 6 weeks, usually most of the inflammation has resolved and so too the pain for you. However, if it doesn't, the sling may need to be moved or cut. Discuss all scenerios with the uro or gyno.

revolving as I am evolving... said...

I had this surgery 6 weeks ago. It was a more difficult recovery than I anticipated, but so worth it. It's life changing. I still have a small amount of tenderness on the right side on my pubic bone just below the incision. But other than that I feel great.
I was unable to void post-op and did go home with a catheter for 5 days. I also noticed a slower stream of urine for a week or two, but that seems better now as well. I would also like to mention to others please don't get discouraged. I was so tired for about 5 weeks post-op, and then turned a corner.
I started yoga again yesterday, but I'm going to wait another week or two before doing any high impact exercises.
I am 46 years old and have 4 children.

minnamo said...

I had this procedure done in November and highly recommend it! I could not void myself initially but it was determined that I had a UTI and was walking too much. Once the UTI was treated and I slowed down all was fine. Yes I can Jump, Cough, Sneeze and Run...very pleased with the results! Maggie

Beth said...

I had the surgery a week ago yesterday. I came home with a catheter. I got the catheter removed after 2 days and then was shocked when I had trouble urinating at all! I took warm baths to relax and release the urine. Now the first time I urinate in the morning it is slow, and I don't completely empty my bladder. I need to wait and go again. I have NO pain, but am so fatigued. I need a nap every 2-3 hours. I went back to work for a half-day today and am really tired. Walking is also exhausting. I also have a stronger urge to urinate. I hope this will all work itself out and I will enjoy the results of the surgery!

Anonymous said...

I've had the TVT bladder sling implanted 17 mos ago and it has ruined my life. I'm in pain constantly, have frequent UTI's, can't walk more than few mins at a time, or sit for long, can't have relations with my husband. I can't void properly, have to sit on the floor with a bowl to void, otherwise, I sit on the toilet for 20 mins and I still retain urine. Haven't been able to return to work because of the severe pain, like something is stabbing and tugging near my bladder. I would not recommend this surgery. I have learned the TVT mesh never FDA approved.

Matthew E. Karlovsky, M.D. said...

The TVT mesh was the fist mesh sling, and of course it is FDA approved, otherwise how could be sold or marketed. Your problem sounds like the mesh is too tight. It likely needs to be cut thereby releasing the pressure and allowing resolution of the pain and urinary issues. Go see a urologist to be evaluated and treated.

Amanda said...

I see there are a lot of negative experiences on this site regarding post-op success. For those who are just coming out of it, yeah the first week is a pain! The surgery was outpatient and there was no need for a catheter. Initially, I couldn't walk, I hobbled -- that lasted for about a week. I did have some bladder spasms the first day after surgery which made me worry because I peed on myself with zero warning. However, after week two I feel fine. My SUI insn't an issue. If I have to hold it, I can. The bruising around the stitches are still tender, of course. I go for the Uro-flow study in April. I'll post back for me details.

Anonymous said...

i had a sling put in 2 weeks ago.had a catheter in for 3 days them removed.i was not able to urinate,had to return back to dr & had another catheter put in for 5 more days then removed.had trouble urinating so the dr gave me tamsulosin to help me urinate.Im in a lot of pain when i urinate & scared i wont recover.it hurts so much when i urinate.then in the morning i have urgency to urinate & cant until i drink something.its a ugly feeling.so scared,willi recover?

Matthew E. Karlovsky, M.D. said...

@Anonymous from May22:
It appears the sling may be too tight. Proper bladder function is also a requirement for good voiding after sling surgery. You need to return to the uro or gyn who performed it and may need urodynamic testing to assess the bladder, but if your voiding remains strained, the sling may need to be cut. You need close follow up with your doc.

Anonymous said...

I had the tvt procedure in 2004 Ethicon. in the past 4 years I have progressively gotten worse. So much so that I have have almost continuous uti and vaginal infections. I have less control now over urine control then I did prior to procedure. I am pain majority of the time. Sex is much to painful and has caused me to bleed. My gynecologist has ruled out everything except the sling. Is this common to happen. How can I find out if it is the sling causing this problem? thank you so very much

Valrie said...

Should you have the sling checked at any point after the initial surgery follow-ups? I had mine done in 2008, had two follow up appointments post-op. I have since moved from the state where the operating physician is located. Any suggestions regarding long-term follow up?

Eileen said...

I had this procedure done 11 weeks ago. My recovery was uneventful beyond the usual post- op discomfort and the need for a catheter for 4 days. I would say the surgery was a success. I am able to void and have no leaking! However, my attempts at sexual-intercourse have been met with moderate to severe pain. A recent exam by my Gyn revealed thin tissue and a sling that is easily felt in that area. It was suggested that I see the surgeon as he would better be able to assess this finding. The surgeon examined me and agrees there is an area of thin tissue which may be the cause or contributing factor of painful intercourse. There is no visible evidence of the sling. He suggested that removing that segment of the sling may help with the pain. First, he would recommend I try 3 months without intercourse as well as the use of Estrace vaginal cream 0.1 mg, 1g 3 times a week for 30 days, to "thicken" the area of thin tissue. Does it sound like possible erosion of the vaginal tissue? Can erosion be limited to only one area along the sling? Does the use of hormone creams thicken tissue? Is there any advantage of waiting 3 months to remove that segment of sling material? Any other thoughts?

Anonymous said...

Had the surgery three weeks ago along with a partial hysterectomy. I am 40 yrs. I spent one night in hospital and had a catheter. I went home with out a catheter and didn't have any trouble emptying my bladder on my own. i developed a bladder knfection about a week after surgery. The other problem I had is a pain on both sides below incision sights. Sometimes it is very painful, other times just a little discomfort. I have told both uro and gyno and they don't seem concerned.

Anonymous said...

I had the sling surgery three weeks ago. I stayed overnight and returned home the next day without a catheter. I've had no trouble emptying my bladder but am still sore. I too walked bent over from the pain for the first two weeks, but am finally feeling I've turned the corner. I also was exhausted and took a nap every afternoon, but this is also changing for the better. Luckily for me the surgery was well worth it. I do not leak when I sneeze, cough or run the water in the sink anymore.

Anonymous said...

I had this surgery done 8 weeks ago. Went home with a catheter for two days - no problem urinating after. I did have some drainage and tenderness during the 6 week recovery time, but I also had uterine oblation as well - so the drainage could have been from that. I would highly recommend seeing a urogynecologist for this procedure as they have additional training and specialize in this type of surgery. It is wonderful to not leak when I sneeze or cough and I can now chase after my kids without peeing my pants. I feel like I've gotten my quality of life back. For those who have pain or other problems - I'd suggest following up with a urogynecologist who will take the time to correctly diagnose what went wrong with your sling and how to correct it.

Anonymous said...

I had a sling procedure three weeks ago. The first two weeks were great - - just a little discomfort. Week three started with lots of burning and lower back pain. Feels like I am sitting on a "scratchy" something all the time. No infection. No leaking anymore. Thoughts on possible causes???

Anonymous said...

I'm about 5 weeks post op TLH with TVTO. So far things have been healing up quite nicely. I do feel the urge to void is much stronger now and less forceful, but no leakage as of yet. However, I've noticed from time to time a tugging sensation on my urethra. Doesn't really hurt, more of an annoyance. There is no bladder spasms, or burning sensation with urination. Just that tugging sensastion. Any thoughts?

Kathy said...

I had the procedure done 3 weeks ago and went home without a catheter. When I came to after surgery, I needed to use the restroom and had no problem urinating. I continue to void without problem and completely. I still do have discharge and off and on bleeding. Dr. said that was normal for up to 6 weeks. I have not had an accident at all. I love that. I still am tired and try to do stuff and my body tells me not yet. So I listen and enjoy the kids doing the house work.

Anonymous said...

Leaking is much worse after 1 1/2 weeks. That is the only complication for me. I hope this will improve on it's own?

Anonymous said...

I had the sling put in almost 17 months ago. It was to big and came through the wall if the vagina, so 4 months after my urologist went and trimmed it, which before the 2nd surgery still had leakage. The 2nd surgery reversed the first. I had a pelvic floor tack, 3 months ago. I can sneeze and cough and all is well, but as soon as I feel the urge to urinate it is too late. I don't have the ability to hold it at all. Only hoping things get better, went from wearing panty liners to full pads....not an improvement at all.

Becky said...

I had the sling procedure done a week ago, came home without a cath. My stream has been alot slower and I can tell I don't empty all the way. But so far, there has been no leakage which is amazing. The only pain I feel is in my hips from the position my legs were in surgery. I am very impressed with the procedure so far.

Margaret said...

I am one and one half weeks post TVT Surgery, and things have gone as expected. I do have one issue that is concerning me, and have not found any information in my research.

I came home from surgery with my pelvic area very bruised. The incision area on my right side, was especially tender and over the next few days as the overall swelling went down the swelling on the right side did not. I had pulling and discomfort on that side when I moved from time to time.

Six days after my surgery, I called the Doctor who performed my surgery with my concern, and he felt that the cause likely came from a blood vessel that was ruptured and suggested that I apply heat.

Since then (over the holidays) it has gotten bigger each day (about the size of a grape) and is very tender to touch. There are no visible signs of redness, burning or infection externally or internally. When the lump is touched, I can feel discomfort to the right and pain into my hip on the back side. It is also tender below the lump.

I look forward to you response to this matter.

Sincerely, Margaret

Matthew E. Karlovsky, M.D. said...

@Margaret 12/26/11: this is probably, by what you describe, some bleeding that occured under the skin, within the the muscle layers at the entry site of the sling needle carrier. It should resolve slowly but monitor for infection, and redness and have the doctor inspect it.

sweetface said...

hi i had my sling surgery on the 19th dec 2011 and have had had a catheter placed in because i was reatining fluids...when in th ER they said i had a liter and 1/2 and had never seen a bladder expand that much....i saw my doctor days later and he removed the catheter and told me i can insert my own catheter at home to eleviate pressure..how long will i be like this? its really depressing,, i can urinagte if i stand at an agle and put pressure on my bladder and only a lil comes out.
sincerly patricia

Dawn Kaye said...

I had my surgery on Dec 21st, 2011, everything was great until a week ago. I've developed this tan leakage to the point I wear a full pad, as of 3days ago the odor has become so strong that I never feel clean down there. I've noticed that if I dont drink enought water my spasms get to be so terrible that I cry trying to go to void. My dr feels all this is normal, but I'm very nervous that it may not be.

Matthew E. Karlovsky, M.D. said...

@Dawn Kaye:
this could either represent a UTI, a vaginal infection, discharge from the vaginal sutures dissolving, or poor healing of the vaginal incision. You will need to contact the doctor for an exam, cultures and/or antibiotics.

Matthew E. Karlovsky, M.D. said...

@sweetface:
Depending on the sling, your bladder function, and the degree to which the sling was made loose or tight, it sounds like you are not urinating well. You can self - catheterize to help the bladder empty to prevent retention, but if this continues for weeks, you may need to have the sling adjusted, cut, or loosened in the operating room. Please keep in close contact with the doctor and report your bladder's progress on a weekly basis so a proper decision can be made

Cynthia said...

I had my sling 5 days ago and no post op complications. I needed to empty my bladder right after leaving the recovery room. I average one pain pill a day due to discomfort of my right side and lower back. I try to get plenty of rest. So far, I am very pleased with the outcome of my surgery, no leakage, little spotting and mile pain. I returned to work today and being very cautious. I would opt to do this all over again if I had too.

Cynthia said...

I had my sling 5 days ago and no post op complications. I needed to empty my bladder right after leaving the recovery room. I average one pain pill a day due to discomfort of my right side and lower back. I try to get plenty of rest. So far, I am very pleased with the outcome of my surgery, no leakage, little spotting and mile pain. I returned to work today and being very cautious. I would opt to do this all over again if I had too.

bostonuw said...

I had the sling (TVT) surgery 1 week ago today, I did not have to come home with a catheta, but I do notice that I dont feel as though I empty my bladder when I void. My incisions are sore, but they are incisions so I guess that is to be expected. My only real hurdle has been how tired I have been. I am back to work today, but have had to push myself to get through the day. I have had NO leakage, coughing sneezing, and nothing.. Light panty liner only for the spotting... I am very optimistic, that this surgery is going to change my life for the better. Dr Katherine Olsen in Lowell MA was my surgeon, and I cant brag enough about her!!!

Anonymous said...

Beginning of Dec had a total vaginsl hysterectomy and bladder sling. I have slight moistness in a thin poise pad. 4 weeks post op, I'll it get better in time? Went home with a supra pubic cath, it was awfful for those 10 days.

mariana said...

i have the miduretrhal sling insetion on tuesday January 3 2012, everything went well i had the catheter 2 days because the dr found my bladder attached to scared tissue of my previous hysterectomy, so he did to prevent retention, i urinated great no inconvenience but at day 4 i statarted hemorrhage at the point to drip all my legs under my pants,i still having pain in a scale 1 to 10 .being 10 the worst pain i am constantly 6 , the dr sent me complete bed rest , iam in the second day how long i have to expect bleeding? it is a complication or is expected like i am with my period heavy days?

Stephanie said...

Had a Lynx sling implanted on Dec. 23. Came home w/out a cath, void just fine. First week was uneventful. About 8 days after surgery, went to grocery store and after walking a bit, felt a weird feeling in the vaginal area, sorta like something was rubbing or scratching that area. Since then, when I walk more than a tiny bit (not exercise walking, just around the house or on errands), I get this same uncomfortable sensation. It also kind of feels like there's a tampon in there that needs to be readjusted. At my post op visit on Jan. 3, told my doc about this tampon feeling and he didn't seem concerned. A few days later, I called the nurse complained about this again and her voice mail to me was that this is part of the healing process, that there's still swelling in the vaginal area. But WHY didn't I feel this the first week? This is keeping me from doing daily exercise walks. My next appt isn't until the last of Jan and if something's wrong, won't it have gotten worse by then? Other than that weird feeling, most everything else seems OK but I have visions of the mesh not being exactly in the right place. When I'm sitting down or lying down, everything feels fine. What to do? No one at the doc's office seems to think my concerns have merit.

Stephanie said...

After twice telling the triage nurse at my doc's office that I felt something scratchy in my vagina (had Lynx sling surgery Dec. 23, 11), she's told me it's natural - part of the healing process. Today I decided to feel around since it also feels like something is sticking me. Lo & behold, I found a small wire-like object sticking OUT about 1/6 inch long. This CANNOT be normal. I've called and left her a message about this and even took a photo and just sent it to her. No response yet. What to do?

Becky said...

I had my sling placed a week ago today and I'm so happy!! I still instinctively cross my legs or squeeze my thighs when I cough or sneeze, and there is no need! For the first time in 15 yrs I don't leak! I had the sling put in place when my OB/Gyn did my hysterectomy(took my uterus and cervix). I am 36 yrs old, 2 kids. I am so glad I had this done! My bff had hers done about 10 yrs ago, and she's had no regrets either! The pain has been very minimal since waking up post op in the hospital. To me it only feels like bad menstrual cramps when I do have pain. I still have some spotting, but that's to be expected. My biggest concern is moving back to intercourse, or even when orgasm can be achieved. I'm one that never made it 6 weeks post child-birth. It's been a week and I'm already "sexually-antsy"! :(

Anonymous said...

hi, had a hysterectomy and sling put in Dec. 21st of 2011. Healing is going well, but I know I did too much right after surgery. Went shopping the day after and other Christmas things. I was dry initially, but now I'm leaking again. I don't think it is quite as much as before, but I really wanted to be cured. I do need to lose weight, so hopefully my doc will redo my surgery in the spring if I lose 30 pounds, because maybe that will help. Just sad, because I really wanted this leakage crap done with, and to be able to excercise or sneeze ect. and remain dry.

Matthew E. Karlovsky, M.D. said...

To the many women who've left comments since Jan 1 2012:

Surgery requires a period of healing, and eventhough ti is minimally invasive, the body needs to heal and scar teh sling in. Early exercise can move,dislodge or lead to improper healing.

If voiding is difficult afte rthe surgery, this can be from swelling and inflammation, but if the stream is poor and urinating is difficult beyond that, then the sling may be too tight. Some may loosen with time (over 12 weeks post op), but after a properly placed sling, voinding should be normal. If it is not "normal", then the sling may be adjustment, stretching, or to be cut. Go back to the surgeon and insist on a reevalution.

If something is sharp in the vagina after surgery, this can be healing, stitches, etc. If the mesh is actually pushing thru the vaginal skin, then this needs to be addressed right away. Mesh extrusion after a sling is not common however.

Anonymous said...

Back 2010 I had surgery a mesh tape sling under my urethra to reduce incontinence,reduce herniation of bladder. Now I'm having problems again pain on my right side I have bladder infection, and kidney stones on both side. I went to my surgeon today maybe remove the sling. I need more test - It was good but now I'm getting discomfort on-going pains.

Anonymous said...

Back in 2010 I had a mesh tape sling under my urethra to reduce incontinence,reduce herniation of bladder. It went all good. Went to see my surgeon today & explain my issues problems like pains, peeing like something went wrong I feel discomfort on-going pains,cramps. I even pee more than ever I'm not sure if this to do a scare tissues and now I have a bladder infection and Kidney Stones on both side this is terrible. My surgeon ask me if I fell-I look at her u got to be kidding me. My doctor might remove it that's the point fix it.

Anonymous said...

I had a bladder sling done going on 5 weeks now. I went home without a catheter however after about 3 days I went back to the doctor as I was not emptying my bladder completely. They had me cath in the office and I had over 850 cc of urine in my bladder. They sent me home with self caths which I had to do for maybe 3 days. I am now able to urinate with no problems. I believe my stitches are still there but go for a 6 week check up on May 10th. I have sneezed several times with no leakage. I feel the sergery was well worth it but I will say the first week of recovery was hell. It wasn't what I expected at all. I am still recovering but feel wonderful after 4.5 weeks. I agree with previous comments...don't get discouraged.

Anonymous said...

I want to say I am 29 and 19 weeks post pardum. I had a mid urethral sling placed a week ago due to complications during my delivery. I feel like my old self again, every time I moved I would go in my pants. Now...no leaks!!! I was sore after the procedure and was able to void so I didn't need to go home cathed. I can't pick up baby...or do too much now but for how I felt before i can wait until I heal. I am no longer in pain it just feels like a pinch sometimes if I sit funny .

Anonymous said...

Originally, I had the sensation to urinate often and I was told I had a prolapsed uterus. I had no leakage at all. The doctor said he would lift the uterus (sacrospinous vault fixation) and that he would test me during the operation to see if he needed to do the mid urethral sling. I knew I did not want it and I asked him to try not to do it. Sure enough, he did do the sling and I started having trouble right away. They had to cathederize me three times and keep me in the hospital four nights. Then they found I had an infection. I had all the horrible symptoms as everyone here is saying - had to lay down alot, burning, a horrible tight feeling, having to pee always (still!). And now my bladder isn't emptying and it is pooling and making a balloon in my vagina and I have more symptoms of infection. I have been to my doctor several times, saying I feel horrible, like I have to pee, like it is too tight, that there is now a big bulge inside ect. He says it is all normal and to give it time. Today I went to another gynocologist and he was very curious as to why the doctor gave me the sling in the first place as I did not leak and did not want it at all. He looked in my bladder and said it is not emtying and he wants me to do the test at the hospital to check. He put me on antibiotics in the meantime and agrees with me that the sling is probably too tight. I don't know what he will do but he said he could remove it if I need that done. I think it is too tight and the bladder is choked and swoolen and bulging down and ballooning in the vaginal. I don't like the sounds of just cutting the sling and leaving it hanging. I want the bulging to go away and I just want this sling gone. The doctor did test it apparently after the uterus lifting and he felt it needed it so maybe I shouldn't have it removed. But how can they losen it as it doesn't stretch does it? What should I do? If they losen or remove it, will the bulging go away? Or will it go away if I stay on the antibiotics? Or do I have to have the bladder lifted too or the vaginal fixed?

Catherine said...

I had the sling surgery 6 weeks ago. I could not void on my own when I was discharged from the hospital but they sent me home without a catheter and I ended up in the ER that night because I could not void. I thought I was going to burst. That was so painful. I then had to use the catheter for two days. A week after that I got a UTI. I returned to work a week after my surgery. I sit at a desk so my doctor said that would be fine. However, when I sit for a long period of time I feel something on my right side. I can't physically feel anything down there, it's the feeling inside like possibly the sling is not in correctly. But again I don't always feel this, like when I get up in the morning it's not there but as I sit all day is when this discomfort comes back. Do you have any idea what this could be. My doctor examined me last week and told me he couldn't tell and wants me to wait 3 weeks. I am a marathon runner and I did this surgery so I could do what I love to do and now I am worried sick I won't be able to run again.

Catherine said...

Is it normal to feel something when you walk after the sling surgery? when I sit for to long I feel something that doesn't feel like it should be there inside me.

Anonymous said...

I had TVT procedure 7 weeks ago, along with a hysterectomy. The hysterectomy surgery went well and is fully healed. The incontinence issue is better, but at my 6 week post op appointment my ob/gyn checked everything and said I might need to see the urologist who performed the TVT, as she could see undissolved stitches. I kept feeling like something was poking me down there, and called my urologist. Um, those weren't undissolved stitches, it is the tvt mesh protruding into the vaginal area, my incision didn't heal over at all. My Dr. gave me some estrace cream to use for two weeks to see if that will encourage the tissues to heal. I have lower back pain, feel that pokey mesh all the time, I'm just flat out uncomfortable, and not thrilled with knowing I am walking around with an open incision. So, in two weeks, looking at another surgery? I may not be leaking any more, but all said and done, think I should have just had the hysterectomy and not the TVT.

Anonymous said...

tyafter having tvt 6 day ago my question is why do i notice discomfort when i sit down.It has to be a certain way or i will feel stabbing or stinging in my vvagina.

Matthew E. Karlovsky, M.D. said...

For the two prior comments: It is expected to feel poking 6 days after thte sling. Allow it to heal.

To the woman with the TVT and Hyster 7 weeks ago: the sling incision appears to not have healed, but allow it time to heal over the sling. this type of extrusion is not very common but commmonly heals. If it does not, the mesh fibers can often be easily removed in the office.

Matthew E. Karlovsky, M.D. said...

@ Anon June 12: It appears the sling is too tight and needs to be cut.

Matthew E. Karlovsky, M.D. said...

@ Catherine June 21: you had retnetion after sling surgery. Unfortunaltey not all doctors check to see if the patient voids prior to going home. this however should be rountinely done after all sling surgery. Furthermore, you can sometimes feel the sling pulling as it is healing, although this does not always occur. After a long day of straining/being on your feet- it can be felt. this sensatio should go away as the healing process goes on. Eventually it should stop. If it causes persistent pain or pulling, or problems w emptying, then the sling should be released.

Catherine said...

Dr. Karlovsky,
When you say the sling needs to be released do you mean that it needs to be removed or just tension let out? What type of procedure does this entail and what kind of recovery? Thank you so much.

Pam said...

I had bladder suspension surgery last week intravaginally. I have done exactly what the doctor said....stay home for 5 to 7 days and no driving for 2 weeks. I have not had any pain or leakage. I am used to working out 5 days a week and I miss that. But it will be worth it if this heals correctly. I would recommend this to anyone....follow the doctors orders.

Dody Rose said...

What does the removal of a sling involve?

still waiting to pee.... said...

I had a cystocele repair and retropubital sling put in two weeks ago today. My bladder was nicked so I had a catheter for a week post op. At my first void trial I got about 50cc out and was sent home. Within 2 hours I was unable to urinate and went into the office in extreme pain. I was recathed and we tried another void trial yesterday. I was able to fully empty, and even was able to urinate a few times after at home on my own. Unfortunately, about 3 hours after I was home, I couldn't urinate anymore and ended up going in to be cathed again-with 650cc in me.
Our next step is to try again next week and I am going to learn how to self-cath. My worry is that the sling is too tight or that there is other damage now that is preventing me from voiding normally. I am told it just takes time but I am not a wait and see kind of person. I feel like there must be something else I can do. I am not lifting anything more than 5lbs and resting quite a bit. Do I really just need to give it more time or is there something I can do to make sure I get better?
I only have one working kidney and I had this done so that I wouldn't have leakage and pooling problems anymore. I was going for a better quality of life. Hoping I didn't do something to have the reverse effect.

Matthew E. Karlovsky, M.D. said...

Often times with a cystocele repair, the bladder is slow to recover. Certainly the sling tension is a concern always, but it is early and I would be patient, and leave the catheter in for 3 days at a time then try to void. Anxiety also inhibits voiding. If the voiding does not recover by 12 weeks, it may be time to consider a sling incision.

Matthew E. Karlovsky, M.D. said...

To Dody Rose,

removing a sling is done for several reasons: either due to pain from the sling, or pain from the sling during sex, or difficulty voiding from the sling, or extrusion or erosion from the mesh. to means going back thru the same incision and cutting or releasing the sling if it is too tight, or actually removing the portions causing the pain. The whole sling is not removed, only the portion around the urethra.

Matthew E. Karlovsky, M.D. said...

To Catherine from July 14-

cutting the sling is done to release it if it too tight and leading to voiding dysfunction or pain. Removing the sling is done if it infected(rare), or the mesh causes pain, or if the mesh is extruding through the vaginal skin.

Anonymous said...

I had POP surgery (sacrocopopexy, hysterectomy, bladder sling) in Dec 2011. I, too, felt a bulge (mentioned in a previous post but not addressed by Dr. Karlovsky) and told my Dr. at my checkup a few weeks later. He said everything looks fine. I've seen other posts where women have this same feeling and need answers. My Dr. said it could be a thickening of the muscle around the urethra. Now 7 months after surgery that feeling is worse. I am in such discomfort. I am aware of it all the time. It is even uncomfortable to sit. It looks like my urethra is larger and even lower than before. What's going on? Why do so many women have this concern and it goes unanswered? Please reply!

Matthew E. Karlovsky, M.D. said...

By your description it is not clear where this bulge is. There should be no bulge. Sometimes the vaginal skin can be prominent or heaped up under the urethra and it is hard to compare the "after" if you do not remember exactly the "before". Nevertheless, if it is bothersome, the have a 2nd opinion by a urologist or urogynecologist. It is also possible to feel pressure from the bulge that want to come down, but is being held up surgically. On exam ther is no bulge but a bulge can be preceived. this is annoying and there is no remedy for Vaginal/pelvic floor stimulation can strengthen the levators and may help this sensation

Hopeful said...

I had a sling surgery a few days ago. I urinated before leaving the hospital--this was a requirement. However, it was not a strong stream and I had difficulty sensing whether I was going or not. I had quite a bit of pain that was managed during the first evening but got up to void with my husband's help with getting to the bathroom. Yesterday, I called the doctor in a panic because I had lost everything in my bladder and filled multiple pads due to an inability to control my bladder. I went in to see him immediately (the day after surgery.) He did not give me a cath because the bladder was "emptying on its own". He will check me again Monday to see if I need one. He said my bladder was in shock and called it bladder apnea. My biggest concern it that I am still leaking. Is it normal not to see benefits right away and to have to wait until after healing has occurred?

Matthew E. Karlovsky, M.D. said...

@ Hopeful:
the bladder can have trouble emptying for a few days after surgery. This is true for any surgery with general or spinal anesthesia. No shock here. But, the urethra and bladder can be inflammed and irritated from the sling leading to the inability to void normally. this is also expected. The sling usually will work riht away, but in some cases, takes some time for scarring to kick in the results. Also, if you are having incontinence, after these surgeries sometime you can experience temporary urge incontinence (uncontrolled urge that leads to leaking), but if the sling is working then you won't have stress incontinence. The urge part is transient and most often resolves on its own. If you still have stress incontinence, let the surgeron know as well.

Rachael said...

I had surgery on 8/6 and have had success with being dry. The only problem I've had is a stabbing pain in my right labia when I walk. I had my post op appointment this afternoon and my doc says everything is healing well and she thinks the pain is associated with the ligament the mesh is sutured to. She said a fluid filed sac formed as a reaction to the sutures and it's pulling the ligament out of place. Her suggestion was a warm bath or heating pad at the incision site to help the fluid reabsorb. Has anyone else experienced this? Is this a common problem? I'm hoping the heat helps and I can walk without a limp by the weekend.

Matthew E. Karlovsky, M.D. said...

@Rachael: I agree with the surgeon's comment. Its post op pain thus far and should resolve w time. anti-inflammatories can help, but so will time and patience

Anonymous said...

Dr. Karlovsky, I just wanted to thank you for taking the time out of your very busy day to answer these questions we all have for you. I think we are all desparate for answers that our doctors don't answer for us. So I just wanted to let you know how much I appreciate you.

Anonymous said...

I had a mid urethral sling placed on Tuesday; voiding fine- feel good.Today, 3 days post op,having vaginal bleeding and some mild right sided cramping.I'm 53 and have not had a period for 11 months.Called surgeon and told to push fluids and call Monday if bleeding increases.Is this normal?

Anonymous said...

I had a midurethral sling on August 2, 2012 for stress urinary incontinence. I felt really good after surgery. No leaking, bled for 2 weeks, pain stopped the day after my surgery. However, In the past week or so I have noticed pain in my pubic mound. It's very mild. My urethra also seems irritated as I can no longer wear jeans (or any pants that put any pressure on my vaginal opening) otherwise it causes mild persistent burning that goes away after a few hours. I can urinate, but when this irritation occurs, it takes a few seconds to start the stream. I don't have a yeast infection, but I'm not 100% sure if I don't have a UTI. It doesn't burn when I pee. Side-effect from the mesh?

joanne fink said...

i had this procedure done in july 2012 and had no problems with surgery and recovery. This being said i used to be multi-orgasmic before surgery but now am lucky to have 1 maybe 2 and used to squirt while haveing orgasm but now nothing like that. Is there anything i can do to make better....

Anonymous said...

I had the sling procedure 2 years ago. I and my husband have been thinking about having a 3rd baby. I want to know the risks, complications, and possibilities of having another child after the mid urethral sling procedure?
Is it possible to have a vaginal birth and not a c-section with the sling? Or it is better to remove the sling?
Thanks

Anonymous said...

I had the sling procedure 2 years ago I and my husband have been thinking of having a 3rd baby. I want to know the risks, complications and possibilities of having another child?

Anonymous said...

I am 38, and had a mid urethral sling put in two weeks ago. I chose the surgery because I like to run and take a Zumba class and would have to do such wearing a pad all the time due to urine leakage. I tried medication first, which didn't help, and a pessary, which worked but cased sever cramping within 20 minutes of my workout.

The surgery was mostly uneventful other than having my bladder punctured and being sent home with a catheter for 2 days. I have returned to normal exercise routines and can report the surgery was successful in that I no longer leak upon exertion. I have no problems emptying my bladder and only notice that my stream is much slower and it takes a little longer to finish in the bathroom.

My concern, however, is this. I am one of those few women who have always had very strong orgasms. I have always had very wet orgasms. I returned to my normal sex routines with my husband about 10 days after surgery, but was unable to orgasm, which has never happened. My doctor told me I could return to sexual intercourse after a week, but your article says to wait 6 weeks. Is it possible then that I just haven't completed healing? Is lack of orgasm a possible side effect from surgery? I am positive my orgasms were not urine leakage, the fluid clearly comes from my vagina and it is no longer doing such at all.

Matthew E. Karlovsky, M.D. said...

@Anon Oct 24: The sling incision goes thru the vaginal wall. It can affect the "G-spot" and orgasms potentially. Since you are relatively fresh from surgery I would continue to let time and nature heal it

Matthew E. Karlovsky, M.D. said...

@Anon Oct 3: a vaginal birth after a sling is possible, thought it may undo the sling's effect. you do not remove the sling before birth.

Matthew E. Karlovsky, M.D. said...

@joanne fink: the sling goes thru the vaginal skin by the midurethra and bladder neck and thus may disrupt nerves involved in orgasm. Increased stimulation of this area or the clitoris is the way to likely achieve your goals.

Matthew E. Karlovsky, M.D. said...

@Anon Aug 20:
If you are thin or the mesh sling is close to the vaginal skin, it can sometimes irritate and be felt. If it is too tight it can give the sense of pulling or urge to void as well. It is a potential side effect of the sling.

Matthew E. Karlovsky, M.D. said...

@Aug 20 Anon: yes