Midurethral sling surgeries that use mesh are the most common surgeries for leaking performed in the United States.  Many different types of surgeries use mesh (not just bladder surgies). Mesh is safe and lots of well-done studies show this (here’s a link to an official statement about mesh in bladder surgeries and here is something I wrote). But there are lots of reasons why you might not want to use mesh.  There is a lot of media and legal attention on mesh and it may just make you nervous. There are surgeries and procedures that do not use a mesh. And prior to deciding to have a surgery, you should know the bladder surgery options with and without mesh.

Urethral bulking

In this procedure, I inject a material into the urethra.  This increases the urethral resistance and decreases leakage.  I almost always perform this procedure in the office and it takes about 5 minutes once the area is numbed.  There are three different materials that can be used. Coaptite uses calcium hydroxylapatite, macroplastique uses silicone elastomers, and bulkamid uses polyacrylamide. The effect of this procedure may wear off over time and it can be repeated.  Around 60-80% of women are better after this procedure. Because this is a pretty easy experience (no knives, cutting or incisions), it is a procedure.

Burch colposuspension

In medicine, we tend to name things in complicated ways. Whenever the prefix “colpo” is used, the word refers to the vagina. It comes from the Greek word “kolpos” meaning womb. In this bladder surgery, I use permanent sutures instead of mesh to resupport the tissue underneath the urethra (which is the vagina). I can perform this surgery laparoscopically or through an abdominal incision.  There is no vaginal incision. The success rate is around 80%. You can read more details about this surgery here.

Pubovaginal sling

This bladder surgery resupports the urethra using a material that is not mesh.  I have to make both a vaginal and an abdominal incision to perform this surgery.  The material used is usually your own tissue taken from another part of the body. I use rectus fascia when I do this surgery which is the covering on your six-pack muscle. You can also use tissue from the leg muscles or cadaveric (yep, tissue from dead people) tissue.  There are new materials being developed all the time. Pubovaginal slings are a big surgery with a long recovery time but they are also the most effective non-mesh surgery with around a 85% success rate. You can read more details about this surgery here.

Each one of these surgeries is a great option for the right person. It is important to review the pros and cons of each with your surgeon. And to think about what you want from the surgery and the surgical experience.

1. Fusco F et al Updated Systematic Review and Meta-analysis of the comparative data on colposuspensions, pubovaginal sling, and midurethral tapes in the surgical treatment of female stress urinary incontinence.  Eur Urol 2017. 72(4):567-91.

2. Siddiquui ZA et al. Intraurethral bulking agents for the management of female stress urinary incontinence: a systematic review. Int Urogynecol 2017;28(9): 1275-84