If you have tried everything to help your leaking and still aren’t as dry as you want to be, you may be considering surgery. There are different types of surgeries for bladder leaking. A midurethral sling is the most commonly performed in the United States . In fact, 99% of sling surgeries in the US are midurethral slings. But what is a midurethral sling and how often does it fix the problem?

What is a midurethral sling?

A midurethral sling is a surgery to treat stress urinary incontinence.  In this surgery, the surgeon places a small strip of mesh underneath the urethra through a vaginal incision. In addition, there are generally two half inch incisions above the pubic bone or in the groin. There are other surgeries that do not use mesh including pubovaginal slings. So, while this post is about mesh surgeries, you need to know that surgery can be done without mesh. 

Mesh incontinence surgeries are successful, are easy to perform and have a quick recovery.  There are pros and cons to using mesh.  And while this is a very important discussion, it is not my current focus.  You can read a statement on mesh for incontinence from the American Urogynecologic Society and the Society for Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction here. So, what are the different types of midurethral slings?

Retropubic sling

Most mesh slings have an entry point (where they are initially placed) and an exit point (where the mesh exits the body) and they are named based on the path of the mesh.  A retropubic midurethal sling is placed with a vaginal incision and two incisions just above the pubic bone.

Transobturator sling

A transobturator midurethral sling is placed with a vaginal incision and two incision in the thigh crease. There will be an incision in the right thigh crease and on the left. More information on these surgeries can be found here.

Single-incision sling

There are newer midurethral slings that only have a vaginal incision. These slings are called single-incision or mini-slings. Because they are newer, there is not much long term data on their success. And because of this lack of data, I am not going to say more about them.

How often does a midurethral sling fix bladder leaking?

Midurethral slings have been well studied and there is much data on them. We know that retropubic midurethral slings work better in women who are heavier and who have worse leakage. But for the average woman, the success rates between a retropubic and transobturator sling are about the same. A midurethral sling cures incontinence 62-98% of the time, depending on the study.  Long term cure rates are similar and range from 42-92%.  This big range in success rates really depends on 1. how the study was done and 2. what type of women were included in the study.  In general, I expected around a 85% cure rate with most women feeling much dryer.  When asked, 85% of women who have had a sling consider it to be a success. And that is probably the most important number.

Bretschneider CE et al.  Rates of sling procedures and revisions- A national surgical quality improvement program database study. Female Pelvic Med Reconstruct Surg 2020. Doi:10.1097?SPV0000000000000995. online ahead of print.

Joint writing group of AUGS and IUGA. Joint report on terminology for surgical procedures to treat stress urinary incontinence in women.  Female Pelvic Med Reconstruct Surg 2020;26(3):162-72.

Ford AA et al. Midurethral-sling operations for stress urinary incontinence in women.Cochrane Database System Review 2017;7(7):CD006375.doi:10.1002/14651858.CD006375.pub4.

Kim A et al. Retropubic vs transobturator midurethral  slings in patients at high risk for recurrent stress urinary incontinence: a systematic review and meta-analysis.  J Urol 2019;202(1):132-42.

Bach F et al. The effect of body mass index on retropubic midurethral slings. AJOG 2019;220(4):371e1-e9.