Urethral Sling Reduces Risk of Incontinence after Surgery for Bladder Prolapse

Posted on June 28th, 2012 by

Among women who are undergoing surgery for bladder prolapse, an additional procedure to place a mesh “sling” under the urethra reduces the risk of later urinary incontinence, but increases the risk of complications. These results were published in the New England Journal of Medicine.

In women, the organs of the pelvis—such as the bladder, uterus, vagina, and rectum—are supported and held in place by connective tissue and the muscles of the pelvic floor. When this supportive tissue weakens or is damaged, organs may drop from their normal position. This is referred to pelvic organ prolapse (POP), and it is a common but treatable problem in women.

For women with bladder prolapse, treatment may involve surgery to move the bladder back into its correct position. After surgery for bladder prolapse, some women develop urinary incontinence (the involuntary loss or leakage of urine). One approach to managing incontinence involves use of a sling (a narrow strip of material) to support the urethra. A sling can be put into place during prolapse surgery (possibly reducing the risk of later incontinence and sparing women the need for another surgery), or delayed until women find out whether they need it.

To explore the risks and benefits of placing a urethral sling during vaginal surgery for bladder prolapse, researchers conducted a study among 337 women. None of the women had symptoms of stress urinary incontinence at the start of the study. Half the women had a urethral sling placed during their prolapse surgery and half did not.

  • Placement of a urethral sling reduced the likelihood of urinary incontinence. At three months after surgery, urinary incontinence was present in 24% of women in the sling group and 49% of women in the comparison group. At one year after surgery, urinary incontinence was present in 27% of women in the sling group and 43% of women in the comparison group.
  • Placement of a sling also increased the risk of complications. Complications that were more common among women who received a sling included bladder perforation (6.7% of women in the sling group and no women in the comparison group), urinary tract infections (31% of women in the sling group and 18% of women in the comparison group), major bleeding complications (3% of women in the sling group and no women in the comparison group), and incomplete bladder emptying 6 weeks after surgery (3.7% of women in the sling group and no women in the comparison group.

For women who need surgery for bladder prolapse and do not currently have stress urinary incontinence, this study will allow for more informed decisions about the placement of a urethral sling during the surgery. The sling reduces the likelihood of later urinary incontinence, but increases the risk of complications.

Reference: Wei JT, Nygaard I, Richter HE et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. New England Journal of Medicine. 2012;366:2358-67.

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Tags: News, Urology

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