Frequently Asked Questions
Stress urinary incontinence (SUI) is the involuntary loss of urine that occurs during physical activity, such as coughing, sneezing, laughing, or exercise. Approximately 1 out of 3 women over the age of 45, and 1 out of every 2 women over 65, have SUI.1
SUI is the result of weakened muscles that control the storage of urine. Childbirth, in particular, can cause support tissue damage or nerve damage that contributes to the weakening of these muscles. Other factors that predispose women to SUI include obesity and constipation.
UI (urinary incontinence) is a general term for several types of urinary loss. Two of these are SUI (stress urinary incontinence) and UUI (urgency urinary incontinence).
- With SUI (stress urinary incontinence), you leak urine with a physical event that exerts abdominal pressure on your bladder, such as coughing, sneezing, laughing, lifting, or jumping.
- With UUI (urgency urinary incontinence), you leak urine due to a bladder contraction that you cannot control. It is characterized by a feeling of urgency to go to the bathroom before the bladder accident.
You may have one or both of these types of incontinence. You can find more information about symptoms at mayoclinic.org, and you should follow up with your doctor for a proper diagnosis. Your doctor can do simple tests to help confirm your symptoms and determine the cause of your leakage.
As of today, there are no FDA-approved medications for SUI. There are medications for UUI.
Nonsurgical options for treating SUI include pelvic floor exercises, diet and exercise, protective undergarments, behavioral therapy, bulking agents, and pessaries. You should discuss these treatments with your doctor.
The definitive treatment for SUI is surgery. The goal of SUI surgery is to provide support for the urethra in order to mitigate bladder leakage. Surgical options fall into two categories:
The midurethral sling (MUS) procedure is the most common surgical procedure for the treatment of SUI.2 Making a small incision in the vagina, your surgeon inserts knitted polypropylene material—a mid-urethral sling—under your urethra. Your own tissue grows into the sling and forms a “hammock of support” for your urethra, helping to prevent leakage during effort-related activities.
Polypropylene midurethral slings (both retropubic and transobturator) are seen as the gold standard of treatment of SUI in the United States and the developed world. According to a joint position statement written by two leading professional societies, the American Urogynecologic Society (AUGS) and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), “Over 3 million MUS have been placed worldwide and a recent survey indicates that these procedures are used by >99% of AUGS members.”4
Nonmesh Surgical Procedures
These surgical options are alternatives to the midurethral sling:
- The Pubovaginal sling procedure uses tissue obtained from you or from donated cadaver tissue.
- Two procedures—the Burch and the Marshall-Marchetti-Krantz—use stitches secured to either a ligament or pubic bone.
For more information about surgical procedures for SUI, please refer to mayoclinic.org or talk with your physician. Your physician is your best resource for determining which treatment is best for you.
This is a decision that should be made by you in consultation with your surgeon. You should discuss all of your options with your surgeon and which treatment plan is most appropriate for your specific medical situation. However, for moderate to severe bladder leakage primarily caused by exertion, the polypropylene midurethral sling has been shown to be the most effective treatment.5
Your surgeon makes a vaginal incision of about 1.5 cm (a little over 1⁄2 inch) and, using specially-designed needles, places the sling underneath the urethra. No stitches are needed to secure the sling to your tissue. Your tissue will hold the sling in place initially, and eventually that tissue will grow into the sling, securing it in place, and helping to provide the necessary support that minimizes or prevents leakage.
In most cases, the actual sling surgery should last less than 30 minutes6. If your surgeon recommends it, the procedure can be performed on an outpatient basis under local anesthesia with IV sedation. In many cases, sling surgery is performed along with another procedure that your physician may recommend to support a dropped bladder, uterus, or rectum. Your surgeon will discuss these options with you.
Every patient’s recovery experience is unique and your physician will brief you as to what he or she expects in your case. After undergoing a sling surgery, you may experience some minor discomfort and fatigue for the first 24 to 72 hours. Please consult with your surgeon on activities to avoid during recovery to achieve optimal outcomes.
You should have a discussion with your physician about the risks and benefits associated with the placement of a midurethral sling. As with any medical procedure, complications can occur from the surgery. According to the FDA, “the most common complications reported through MDRs for surgical mesh slings for SUI repair, in descending order of frequency, include: pain, mesh erosion through the vagina (also called exposure, extrusion or protrusion), infection, urinary problems, recurrent incontinence, pain during sexual intercourse (dyspareunia), bleeding, organ perforation, neuro-muscular problems and vaginal scarring. Many of these complications require additional medical intervention, and sometimes require surgical treatment and/or hospitalization. With the exception of mesh erosion, the above complications can occur following a non-mesh surgical repair for SUI.”7
For a full list of Warnings and Precautions related to each sling, go to section 2.3 of any UroCure IFU. Click here to access the IFUs.
There is no surgery for incontinence that has a 100% cure rate, but sling surgeries for bladder leakage have been performed and studied since the 1990s and have been shown to have high success rates of 80-95%.8 Other incontinence procedures are possible after sling placement. If necessary, inform your surgeon about having a sling when considering additional treatment options.
- What surgical or non-surgical treatment options are available and what do you recommend to treat my SUI?
- Have you had specialized training in the surgical treatment of SUI, and if so, what type of training have you had with this particular product and/or procedure?
- What can I expect after surgery and what is the recovery time?
- If I also have pelvic organ prolapse, will that change how you treat my SUI?
- What if the surgery doesn’t correct my problem?
- Which side effects should I report to you after the surgery?
- Are you planning to use a mesh sling in my surgery? If so:
- How often have you performed this surgery using this particular product? What results have your other patients had with this product?
- What are the pros and cons of using a mesh sling in my particular case? How likely is it that my repair could be successfully performed without using a mesh sling?
- Are recovery times different for mesh sling surgery compared to non-mesh surgery?
- Will my partner be able to feel the mesh sling during sexual intercourse?
- If I have a complication related to the mesh sling, how likely is it that the complication can be resolved? Will you treat me or will I be referred to a specialist experienced with mesh sling complications?
- Is there patient information that comes with the product, and can I have a copy?
1 US markets for Urological Devices. Millennium. Oct 2010. Report US31UR10
2 Position Statement on Mesh Midurethral Slings for Stress urinary Incontinence, American Urogynecologic Society (AUGS) and The Society for Urodynamics, female Pelvic Medicine and
Urogenital Reconstruction (SUFU), Updated February 2018.
4 Urinary Incontinence PocketGuide, American Urogynecologic Society (2010): In Women (PocketGuides (International Guidelines Center)).
5 Barry C et al. (2007) A Multi Center Randomized Clinical Control Trial Comparing the Retropubic (RP) Approach Versus the Transobturator Approach (TO) for Tension-Free, Suburethral Sling
Treatment of Urodynamic Stress Incontinence: The TORP Study. Int Urogynecology J 19:171-178.
7 Primus G (2006) One year follow-up on the SPARC sling system for the treatment of female urodynamic stress incontinence. Int J Urol 13, 1410-1414.
IF YOU ARE THINKING ABOUT SLING SURGERY, OR IF YOU HAVE UNDERGONE SLING SURGERY FOR SUI AND HAVE CONCERNS ABOUT THE USE OF MESH, THE UROLOGY CARE FOUNDATION OFFERS THIS ADVICE:
Talk to a urogynecologist or urologist about what options are best for you. A urologist or other female pelvic medicine reconstructive surgeon should be able to explain all of your treatment options and their risks and benefits. Feel free to ask them questions until you feel confident in the choice you make together about the treatment that is right for you.
Before surgery, ask about which type of sling (mesh or human tissue) will be used. You should learn what results to expect and why this surgery is being recommended for you.
Ask your doctor how often they have done this surgery, what training they have and what side effects their patients have seen.
Learn about potential side effects and their cause. It is important to recognize bad side effects so they can be taken care of right away. Many side effects of sling surgery for SUI may not be related to the mesh. Some problems can happen with non-mesh sling surgeries as well. Talk with your doctor about what symptoms (such as bleeding, pain or problems urinating) need immediate attention.