The Pros & Cons of Sling Surgery

While scrolling through our comments section on Facebook, we often read statements like: "Just get the sling surgery! Best thing I ever did." These comments are usually followed up with someone else chiming in to say that "surgery doesn't work for everybody!" or "it worked for me but only temporarily." We were stumped. Why did the surgery work for some women while others didn't have much luck? So of course, learning more about the pros and cons of sling surgery was a no-brainer. 💁🏽

We spoke to Carol and Debbie, two amazing women who were comfortable sharing their bladder surgery stories, as well as Dr. Kimberly Ferrante, a uro-gynecologist from NYU's Langone Health Center.

When is sling surgery recommended?

Dr. Ferrante says that a urethral sling surgery is done to eliminate stress or mixed (urge + stress) incontinence. Stress is the one where you dribble when you cough 😮, laugh 😂, jump, run 🏃🏾, skip, dance 💃🏽, ok you get it. While Urge is what makes you feel like you're going to throttle anyone who's blocking your path to the restroom.

As Dr. Ferrante emphasized, the sling surgery is for women dealing with stress or mixed. Typically, she says, the surgery is recommended for women who 1) are bothered enough by their leaking that surgery feels like the only other option (note: there are lots of other options for many women so be sure to research and consider them), and 2) are done babymaking. 

What’s the difference between a vaginal sling and mesh?

We learned that when people talk about vaginal slings or meshes, the procedures are usually lumped into the same category or used interchangeably. But, vaginal slings and transvaginal meshes are totally different surgeries. Slings (a.k.a urethral sling surgery or mesh sling procedure) are usually used for stress incontinence. A transvaginal mesh surgery is used to repair pelvic organ prolapse. Slings are typically quite small while the size of meshes used for prolapse can vary and usually require more material.

Ok, now that we're surgery smart, let's dive deeper.

What happens when a mesh surgery gets complicated?

Carol, a 77-year-old Ohioan, told me that her transvaginal mesh surgery worked, but only for about 2 years. Ten years ago, when Carol met with her uro-gynecologist for an exam before the surgery, she didn't feel like he had the best bedside manner. Still, she proceeded with the surgery. After having a hysterectomy over 30 years ago and coping with pelvic organ prolapse, Carol said her leaking problems got worse. She was tired of wearing disposables to deal with dribbles and didn't want her prolapse to get worse. "Wearing pads got so expensive and frustrating," she said. "I wanted to improve this problem because nothing else was working."

But then, two years after surgery, Carol felt pain in her pelvic region. Then, she realized that she was bleeding vaginally. "The pain was excruciating," she said. When she saw the mesh coming out, she realized that it was the source of her sudden pain.

Some women like Carol who have had transvaginal mesh have also experienced pain, bleeding, or erosion (meaning the mesh moved through their vaginal wall and, in a few cases, into other organs). The FDA issued warnings about it in 2008 and 2011. Finally in 2014, they released another notice stating that surgical mesh for transvaginal pelvic organ prolapse should be reclassified from a moderate-risk to high-risk surgery. 😬

Thankfully, Carol had no scarring from her transvaginal mesh surgery, but she still copes with leakage.

"I would suggest women to check out their gyno or urogyno very carefully," she advised "Catch incontinence as soon as it starts and don't go through life like I did with it for years."

...And what happens when sling surgery is a success?

Debbie is 61-year-old mother of one. Her leaking woes started shortly after giving birth to her daughter 28 years ago. "Being a mom and caretaker, I kept putting myself off," she explained.

But then, a few years ago, she started trying everything from core exercises to a pessary, but neither stopped the leaking for long. She had reached her threshold. Debbie decided "enough is enough!" and that it was time for a urethral sling surgery (not transvaginal mesh). 

During the outpatient surgery, a sling is placed around the urethra to lift it back into a normal position and create a hammock to keep you from leaking. Studies show that about 8 out of 10 women might be cured after the surgery. Some may still have some leakage because other problems are causing incontinence. Over time, some women say that the leakage can come back. To increase the chances of a successful surgery, doctors recommend quitting smoking and doing pelvic floor exercises. 

It can take anywhere from 2 to 6 weeks to recover fully from the surgery. Dr. Ferrante advises that women don't lift heavy objects or participate in strenuous activities (sorry, no kickboxing 😉). If there's difficulty peeing, the sling may need to be readjusted or removed.

A few weeks after surgery, Debbie rejoined her friends in a knitting circle. The women chatted and knitted. After a friend told a funny story, they all started laughing hysterically. Suddenly, all eyes were on Debbie. She knew why they looked over at her. Then, she exclaimed, "I did not even leak, you all!" Everyone clapped.

After years of leakage stress, Debbie could finally laugh without worry.

So whether you opt for surgery or are hips deep into pelvic floor therapy, be sure to talk to a trusted medical professional about your options. Remember, as Carol advised, always ask questions if something's unclear or you don't feel right about a diagnosis or method of treatment. 

Have you considered getting a sling surgery, or have an experience with the surgery already? Share your story with us in the comments.