Atrium Health Navicent Women's Care Urogynecology & Pelvic Surgery

Retropubic midurethral sling

What is a retropubic midurethral sling?

A retropubic midurethral sling is a procedure to correct stress urinary incontinence (SUI). SUI is a type of urinary incontinence that is defined as involuntary leakage of urine related to an increase in intraabdominal pressure that occurs during sneezing, laughing, coughing or exercise. It is a very common condition that occurs in 1 in 3 women.

SUI occurs when the supports of the urethra are weakened allowing for hypermobility or instability of the urethral. The midurethral sling utilizes a small piece of mesh to support the midurethral and ultimately decreases hypermobility. The retropubic approach to the midurethral sling describes the course of the sling which curves around the pubic bone and exits through two suprapubic incisions. While it can be used as a first line sling for SUI, it is typically used in some special situations:

• Recurrent SUI
• Urodynamic testing revealing a low leak point pressure
• Intrinsic sphincter deficiency

How is the procedure performed?

Retropubic midurethral slings are performed by making a small incision in the vaginal and two small incisions in the suprapubic region. After periurethral tunnels are created, a special trocar (sling placement device) is utilized to place the mesh under the midurethra and exit the suprapubic incisions. Cystoscopy is typically performed afterwards to confirm that no injury to the bladder was sustained. It is a very effective treatment and is recognized as the standard of care for treatment of stress urinary incontinence

What should I expect?

After initial consultation with Dr. Kow, you may be asked to undergo some bladder testing (urodynamics) prior to surgery. Prior to surgery, you will need to attend a preoperative visit with Dr. Kow and draw some basic lab work. Should you need surgical clearance, you will be asked to obtain this prior to surgery.

The surgical procedure takes less than 30 minutes to perform. You will have two small incisions in the suprapubic region after surgery. If performed by itself, it is an outpatient procedure and does not require an overnight stay. However, it is often performed at the time of other surgeries such as prolapse surgery. If it is performed with other procedures, you may require an overnight stay and be discharged the following day.

Overall recovery time includes six weeks with some activity restrictions, however patients are often able to return to a normal routine shortly after surgery. Restrictions including the following:

• No heavy lifting of more than 10 lbs for 6 weeks
• No tub baths for 6 weeks
• No sexual intercourse for 6 weeks
• No driving while on narcotic pain medications

What are the risks of the procedure?

Complications from a retropubic midurethral sling are typically very low. However with every procedure there always some risks including anesthesia problems, postoperative pain, intraoperative bleeding, infection, blood clots and damage to adjacent organs. With regards to a retropubic midurethral sling, some specific risks include the following:

• 5-10% risk of postoperative urinary tract infection
• 1% risk of mesh exposure
• 1-5% bladder injury

This procedure is a safe and effective surgery that is the treatment of choice for correction of stress urinary incontinence. While there has been confusion regarding the use of mesh, a recent position statement by the American Urogynecologic Society and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction summarizes the safety and efficacy of the procedure.

AUGS/SUFU Position statement on Mesh Midurethral Slings for Stress Urinary Incontinence

Will my insurance company cover the procedure?

Most insurance policies will cover retropubic midurethral sling. Our office will help you with obtaining prior authorization if your insurance policy requires it. If you have further questions, contact your insurance carrier to determine the details regarding your coverage.