Urinary incontinence is a debilitating condition that significantly impacts quality of life for millions of women worldwide. Stress urinary incontinence (SUI) accounts for more than 50% of cases. For those seeking relief, surgical options, such as mid-urethral sling surgery, have become common but are not without risks. The “sling” acts like a hammock to lift and support the bladder and urethra to help prevent bladder leaks. However, while sling surgeries are typically effective in the short term, they are not without side effects and potential long-term complications. Let’s explore the side effects, long-term efficacy, and emerging alternatives for treating stress incontinence.

What Are Sling Surgeries?

Mid-urethral sling surgeries are the gold standard surgical produce for stress incontinence. The surgery places a mesh sling under the urethra and bladder neck to provide support during activities that increase abdominal pressure, such as coughing, sneezing, or exercising. The goal of this surgery is to keep the urethra closed when you exert pressure on the bladder to prevent urine leakage – but this surgery does not address pelvic muscle weakness, the primary cause of stress incontinence. Mid-urethral sling surgeries are often minimally invasive and have high success rates in terms of symptom relief immediately following the procedure.

However, the question remains: what happens years after the surgery? More than 50% of women will continue to report stress incontinence up to 11 years later and more than 1 in 4 women will require more than one surgery. Complications and poor outcomes can significantly impact a woman’s health and quality of life.

Common Side Effects of Sling Surgeries

While many patients experience initial success, sling surgeries can lead to various short- and long-term side effects, including:

1. Bladder Perforation

This can occur during surgery from the mesh or a surgical instrument puncturing your bladder. This can lead to bleeding, pain, and the need for additional surgery to correct the perforation.

2. Pain and Discomfort

Many women report persistent pelvic or vaginal pain after surgery. This discomfort can interfere with daily activities and significantly diminish quality of life. In some cases, pain may result from a nerve injury or mesh-related complications.

3. Urgency Urinary Incontinence

Ironically, some patients experience new or worsened symptoms of urge incontinence after a sling surgery. Urgency urinary incontinence, characterized by a sudden and uncontrollable need to urinate resulting in an accident, can occur due to bladder irritation or obstruction caused by the sling.

4. Continued Stress Incontinence

Despite the surgical attempt to support the urethra and bladder, some women will continue to have stress incontinence and require additional treatment interventions.

5. Mesh Erosion, Exposure, or Extrusion

When the sling material wears through the vaginal wall or into nearby organs, serious complications result. This can lead to infections, bleeding, and the need for additional corrective surgeries.

7. Sexual Dysfunction

A significant yet under-discussed side effect of sling surgeries is sexual dysfunction. Women may experience pain during intercourse (dyspareunia), reduced sensation, or emotional distress related to the physical changes brought on by surgery.

8. Infection and UTIs

Infections related to the surgical site or the mesh material itself are another potential side effect. These infections, along with recurrent UTI complaints, may require antibiotics or, in severe cases, removal of the sling.

9. Urinary Retention

Some individuals find it difficult to empty their bladder completely after a sling procedure. This can lead to a feeling of incomplete relief and an increased risk of urinary tract infections (UTIs).

10. Emotional Distress

Beyond physical discomfort, complications like chronic pain, incontinence recurrence, or sexual dysfunction can lead to frustration, anxiety, or depression. The psychological toll can sometimes be as challenging as the physical symptoms.

Long-Term Efficacy: Is Sling Surgery a Permanent Solution?

While sling surgeries are often promoted as long-lasting solutions for SUI, their efficacy can diminish over time.

• Recurrence Rates: Studies have found that up to 50% of women experience a return of urinary incontinence symptoms within 10 years of the procedure and 14% experience recurrence in as little as 3 months.
• Need for Revision Surgery: The need for secondary surgeries, either to address complications or to restore effectiveness, is not uncommon. Research finds rates as low as 3.7% up to 29%. This highlights the importance of understanding the long-term implications of these procedures.
• Removal of Mesh: Roughly 60% of revisions/removals are due to mesh erosion.

Additionally, changes in a woman’s body over time, such as menopause, weight fluctuations, stress, or further weakening of pelvic floor muscles, can impact the durability of the sling’s support.

Alternatives to Sling Surgery: Safer and Effective Solutions

Given the potential risks and complications, many women are now exploring non-surgical alternatives for managing urinary incontinence. These options can often provide relief without the risks associated with surgery:

1. Flyte: A Clinically Proven At-Home Solution

Flyte, an FDA-cleared and clinically proven medical device for stress incontinence. Flyte is an innovative device that uses mechanotherapy to strengthen and tone the pelvic floor muscles. Offering surgical-level results for mild, moderate and severe SUI in just five minutes a day for six weeks, Flyte is a convenient, safe, first-line, non-invasive alternative to sling surgeries to restore continence quickly with lasting benefits. It’s particularly appealing for those who prefer to avoid the risks associated with surgery and the side effects of mesh. Studies show that Flyte’s effectiveness rivals surgery, making it an excellent option for long-term results.

"Definitely consider the FDA-cleared Flyte device as an alternative to surgery." - Dr. Nissrine Nakib, MD (Medical Director of Urology at M Health Fairview & Assistant Professor of Female Urology and Urodynamics at the University of Minnesota)

2. Pelvic Floor Physical Therapy

Working with a pelvic health physical therapist can strengthen the muscles supporting the bladder and urethra, providing natural relief from incontinence symptoms. Tailored exercises such as Kegels and functional movements can improve muscle coordination and control, reducing leaks during physical activities.

Don’t have time for in-person physical therapy? Try the Flyte system where you additionally gain access to Doctors of Physical Therapy specialized in pelvic health to support you while using Flyte.

3. Lifestyle Changes

Small but consistent lifestyle adjustments can significantly improve bladder control. Strategies include:

• • • Bladder Training: Gradually increasing the time between bathroom visits can improve bladder capacity and reduce urgency. Check out our blog post THE MENOPAUSE – INCONTINENCE LINK: MYTH OR FACT?  for more information.
    • Dietary Changes: Avoiding bladder irritants like caffeine, alcohol, soda, and spicy foods can help minimize symptoms. Read Sip smarter by learning to manage these 4 bladder irritants for more details.
    • Weight Management: Reducing excess weight decreases pressure on the bladder and pelvic floor.

4. Pessaries

These removable devices, inserted into the vagina, provide support to the urethra and can be a viable non-surgical option for some women. Pessaries are particularly effective for mild to moderate cases of stress incontinence while inserted.

If you have any abnormal discharge, consult with your healthcare provider for signs of infection as pessaries remain inserted for prolonged periods of time.

Advocating for Informed Decisions

Given the complexities and potential risks of sling surgeries for stress incontinence, it is crucial for patients to be well-informed about their options. Here are some tips for advocating for your health:

1. Ask Questions: Don’t hesitate to ask your healthcare provider about the risks, side effects, benefits, and alternatives to surgery. A thorough understanding of your available options can help you make an informed decision.
2. Seek Second Opinions: Consulting with another specialist can provide valuable insights and confirm whether surgery is the best option for your unique situation, or if there are new non-invasive treatment options available, like Flyte.
3. Consider Non-Surgical Treatments First: Starting with conservative treatments like Flyte allows you to explore effective solutions that deliver results comparable to surgery without committing to invasive procedures.

Conclusion

While sling surgeries can be effective for treating stress urinary incontinence, they come with a range of potential side effects and long-term risks that should not be overlooked. Women considering this option should have a thorough discussion with their healthcare provider about the benefits, risks, and possible alternatives. Non-invasive treatments like Flyte offer promising outcomes without the complications associated with surgery, making it an excellent first-line treatment for stress incontinence.

 

 

References

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