Anytime I do anything to treat bladder leakage, it changes the way you empty.  You may not have thought about this.  But a medication, a procedure, a pessary, or a surgery can make it a little harder to empty.  Even overtightened pelvic floor muscles can make it harder.  Usually the changes are subtle but you will notice them.  So how do you empty after a bladder sling (click here for more info on sling surgery)?

Changes in emptying

The way you empty your bladder is a habit.  You don’t think about it, you just do it.  After surgery, you may notice changes like:

• Your urine stream is slower
• Your urine stream takes a few minutes to start
• You empty your bladder, wait a few seconds and then more empties

Emptying after a bladder sling surgery

Right after a surgery, we need to make sure you can empty your bladder.  About 10-20% of the time, women will have trouble emptying their bladders for 1-2 days.  This is because of the anesthesia, the local numbing medicine, and the swelling.  This problem will go away with time but you may need a catheter while it does.  If it does not go away in 1-2 days, your sling is likely too tight (ie it works so well that you are totally dry but can not pee) and it needs to be modified.

So, after surgery, we have you empty your bladder and then measure how much is left.  There are three different ways this can be done.

1. When you leave the operating room, a catheter is in your bladder. I can fill up your bladder through the catheter, take the catheter out, and then have you empty.  As long as you empty more than half of what I put in, you are emptying well enough.  It will improve with time.
2. You can empty your bladder and then I can do an ultrasound to see how much is left.
3. You can empty your bladder and then I can catheterize you to see how much is left. I try to avoid this because it is the most uncomfortable.  Sometimes, it needs to be done.  Like if you really can’t empty at all.

You may have heard of a “suprapubic catheter.”  This is a catheter that is surgically placed and drains your bladder above the pubic bone.  These are still used but rarely and only in complicated cases.  It is uncommon to have this type of catheter placed.  So I wounldn’t worry about this.

When a sling is too tight

Slings can be too tight.  This happens around 1-2% of the time.  So, not very often but it absolutely happens.  If this is the case, I wait 2 weeks and then cut the sling.  I wait the 2 weeks because the sling is likely to be scarred in place at that time and will still work if I cut it.  So, cutting it loosens it so you can empty your bladder but it still should correct your stress incontinence.

Before surgery, I talk a lot about catheters and maybe needing to have one for 2 weeks.  This may seem a little nutty to you, since it only happens 1-2% of the time.  But it is an unpleasant surprise.  I think it is best to know this MIGHT happen, and then be pleasantly surprised when it does not.  Just sayin’.

Ripperda CM et al AJOG 2016;215(5):656 e1-6.