Mid-urethral sling may reduce risk of urinary incontinence after surgery

For many adult women, supporting tissues in and around their vagina weaken to the point where the bladder and other organs descend from their normal position, creating a hernia into the vaginal wall known as pelvic organ prolapse. One in five women will undergo surgery to repair such prolapse.

Vaginal surgery is one way to correct this condition, which often comes with age, but this surgery can also unmask another problem - urinary leakage.

Now, new research by the University of Michigan Health System shows that patients who receive a mid-urethral sling - a permanent mesh-made hammock placed underneath the urine channel during prolapse repair - have less than half the risk of urinary incontinence after surgery. The study's findings were published in The New England Journal of Medicine June 21.

"Pelvic organ prolapse is a common condition among women and can be a major quality of life issue," says lead author John T. Wei, M.D., professor of urology at the University of Michigan Medical School. "Unfortunately, urinary incontinence is a common occurrence following bladder prolapse repair and that incontinence may also be bothersome to the patient.

"Our study found that placement of a mid-urethral sling at the time of bladder prolapse repair can significantly reduce the likelihood of urinary leakage after surgery," Wei adds.

There are different schools of thought on when to use the sling. Some physicians may perform the prolapse repair without a sling, waiting first to see if a patient experiences urine leakage before offering treatment for incontinence. Others insert the sling at the same time as the repair, which adds just minutes to the procedure and avoids the need for a second surgery.

The UMHS study found that inserting a sling at the time of the surgery resulted in less urine leakage three and 12 months later. However, patients with slings experienced higher rates of expected adverse events, including difficulty emptying the bladder, urinary tract infection, bladder perforation and bleeding.

"This gives doctors more data to counsel their patient and gives patients more concrete information on which to base treatment decisions," Wei says. "This is not saying that you have to use a sling but a doctor can now inform women that if they don't put in a sling at the time of vaginal bladder prolapse surgery, 49 percent of the time they will experience urine leakage three months afterwards - compared to a 23 percent chance of leakage with the sling. On the other hand, with the sling, there is a slightly higher chance of side effects."