A retropubic midurethral sling is used to correct stress urinary incontinence (SUI). SUI is when you involuntarily leak urine when sneezing, laughing, coughing or doing exercise. It is a very common condition and occurs in 1 in 3 women.
SUI occurs when the muscles and tissue that support the urethra (the tube that carries urine from your bladder to outside your body) are weakened. The midurethral sling uses a small piece of mesh to support the urethra. “Retropubic” describes the position of the sling, which curves behind the pubic bone and comes out through 2 small incisions above the pubic bone. Although it can be used as a first option to treat SUI, it is usually used in some special situations, including:
Retropubic midurethral slings are usually done by making a small incision (cut) in the vagina and two small incisions in the area above your pubic bone. Your surgeon will use a special device to place the mesh under the urethra and pull the ends through the incisions above your pubic bone.
After the sling is in place, your doctor will insert a tiny camera called a cystoscope into your bladder to check that it was not injured. Retropubic midurethral sling is a very effective treatment and is the standard treatment of stress urinary incontinence.
You may be asked to undergo some bladder testing called urodynamic testing. You’ll need to attend a preoperative visit where you will talk with your provider and about what to expect and undergo some basic lab work. If you need surgical clearance or prior authorization, you will be asked to get this before surgery.
Retropubic midurethral sling procedure takes less than 30 minutes to perform, and you will be under general anesthesia. If performed by itself, it is an outpatient procedure, and you can go home the same day. However, if it is performed with other surgeries, such ones to correct prolapse, you may need to stay in the hospital overnight.
You can expect some activity restrictions for about 6 weeks, but many patients can return to a normal routine shortly after surgery. Activity restrictions include:
The risk of complications from a retropubic midurethral sling is typically very low. As with any procedure, there is a risk of anesthesia problems, pain, bleeding, infection, blood clots or damage to nearby organs, but these are rare. Risks specific to this procedure include:
This procedure is a safe and effective surgery and is the treatment of choice for 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.
Our office will help you get prior authorization if your insurance policy requires it. If you have further questions, contact your insurance carrier for details regarding your coverage.