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Stress Urinary Incontinence: Having Pubovaginal Sling Surgery

Side view cross section of female lower abdomen and pelvis showing bladder, pubic bone, urethra, pelvic floor muscles, vagina, uterus, and rectum. Sling of tissue goes around vagina and attaches to tissue just above pubic bone. Incisions are just above pubic bone and inside vagina.

To help treat stress urinary incontinence (SUI), your surgeon may do a procedure called pubovaginal sling surgery. A “sling” of tissue or mesh is placed like a hammock under the bladder and urethra. The sling helps support the bladder and urethra firmly in place. This helps keep the urethra closed to prevent urine leakage. Your surgery will take about 2 hour(s). You will be asked to do some things at home to prepare for surgery. Below are guidelines to help you get ready. If you have any questions, call your nurse or doctor.

How should I prepare for surgery?

The weeks before surgery

  • Have any tests that your doctor orders.

  • Tell your doctor about aspirin and other medicines, vitamins, or herbs you take. Ask if you should stop taking them before surgery.

  • Stop smoking to help reduce your risks during surgery.

  • If you have been given any prescriptions to fill, do this before surgery.

The night before surgery

  • You may be asked to give yourself an enema. This cleans out your bowels for surgery. You’ll be told how to do it.

  • Follow any directions you are given for taking medicines and for not eating or drinking before surgery.

The day of surgery

Arrive at the hospital a few hours before surgery as directed. Have someone drive you there who can also stay during the surgery, and drive you home. At the hospital, your temperature and blood pressure will be taken. In some cases, tests may be done. Then, you will receive one or more IV (intravenous) lines. These lines give you fluids and medicines before, during, and after surgery. Some of your pubic hair may be removed. Tight stockings (compression stockings) may be put on your legs to help prevent blood clots.

About anesthesia

To keep you pain-free during surgery, you’ll receive anesthesia. General anesthesia allows you to sleep. Regional anesthesia numbs the lower part of your body. Local anesthesia numbs the area that will be operated on. Before surgery, you’ll meet with the anesthesiologist or nurse anesthetist. He or she can tell you what kind of anesthesia you will receive and answer questions you may have.

What happens during the procedure?

  • An incision 2 to 4 inches long is made in the lower part of your belly (abdomen), near the pubic hairline. A second small incision is made in the front wall of the vagina.

  • If tissue from your body is used for the sling, it may be taken from your abdomen or thigh. If synthetic material or donor tissue is used, it is cut to the right size.

  • Working through both incisions, usually 2 lateral incisions right above the pubic hairline, the surgeon places the sling under the bladder and urethra. The ends of the sling are secured to strong tissues in your abdomen.

  • The incision in the abdomen is closed with sutures (stitches), staples, skin glue, or strips of tape (Steri-Strips). The vaginal incision is closed with sutures. Once this incision has healed, it should not cause you problems during sex.

What are the risks and complications?

The risks and complications of this procedure may include:

  • Infection

  • Bleeding

  • Risks of anesthesia

  • Blood clots

  • Damage to nerves, muscles, bladder, or nearby pelvic structures

  • Trouble urinating

  • Urinary urgency

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