Management of sling complications

Management of sling complications
Stress urinary incontinence is a common problem that will require surgery in 1/11 women. The most popular procedure is the mid-urethra sling and its wide availability has made it possible for many women to be cured. All surgeries are not successful and even in those that are, there can be some bumps in the road. So what happens if you have any of the sling complications?
First, it is important to remember that the chance of success is high, so the majority of women undergoing surgery will not have any problems. The most common problems faced after sling surgery include the inability to void completely, a urinary tract infection, failure of the procedure, mesh erosion or exposure, or subsequent voiding dysfunction. All of these can be managed with minimal long term effects.

The possibility of difficulty voiding should have been discussed before the surgery. This happens. Some women can’t void at all while others can only void partially. This usually resolves in 1-2 weeks but you should be prepared to either perform intermittent self catherization or go home with a catheter in place to continuously drain the bladder. If the issue has not resolved in 2-3 weeks at the most, then your surgeon can take you back to the surgical suite to loosen the sling. If the incomplete problem persists for much longer then the sling may need to be cut. Some women experience this incomplete voiding months and years after the procedure and removal of the sling is also a possibility.

Ideally, you will have a 100% cure after the sling surgery however this doesn’t always occur. 75% or more improvement can certainly be considered a success, especially if you have gone from leaking a lot to only losing a few drops. If, however, there is not perceptible improvement then let your doctor know as soon as possible. There is a way to go back to surgery to attempt some type of tightening but the window of opportunity is narrow.
Urinary tract infections are common after bladder procedures and these are usually treated with oral antibiotics. Voiding dysfunction including urinary frequency, urgency and even urge incontinence are potential risks that cannot be avoided. If the dysfunction involves incomplete emptying then cutting or removing the sling is an option. Finally mesh erosions or exposure into the genital region are usually managed by the use of estrogen cream in postmenopausal women or cutting and burying the exposed mesh. Major complications are rare but are managed in conjunction with the appropriate clinical expert based on the scenario.

Sling surgery is an excellent option for those who suffer from stress urinary incontinence which has not responded to conservative measures. Nothing in life is free and no treatment is without risks. Take the time to choose the right provider and partner with them to make sure you fully understand the treatment recommendations, the planned procedure, the potential complications and risks as well as the postsurgical expectations.

I hope this article has provided you with information that will help you make wise choices, so you may:

Live healthy, live well and live long!


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