I’ve always liked the two truths and a lie game.  I think it is a great ice breaker and I always learn something surprising about the people playing.  Lately I’ve been thinking about this approach in my work.  It’s an easy way to test your knowledge on a subject.  So, let’s play.  2 Truths and a lie about sling surgery.

Surgery fixes all leaking

Mesh is the gold standard for surgery

Sling surgeries are easy to recover from

Pick your lie and let’s review!

Do surgeries fix all leaking?

Sling surgeries are designed to help stress urinary incontinence.  In a surgery, we are working to resupport the urethra so it does a better job of holding in urine during high pressure times (think a cough, sneeze, laugh, jump, deadlift).  This is important to understand.  Many women have both stress and urgency urinary incontinence.  The urgency symptoms often remain after surgery (this is not a failure).  Those symptoms can be treated, just not with surgery.  So, with mixed urinary incontinence (both stress and urgency incontinence), you should expect a multistep treatment process.  And if you are someone who’s urgency does improve after surgery (with your stress incontinence), you can be excited that you don’t need the second step.  Clear expectations about your expected improvements are critical-to your confidence in the process and your team.

Is mesh the gold standard for a sling?

There is a lot of concern about mesh and there has been a ton of negative media attention.  I think I talk more about mesh than anything else.  But mesh sling surgeries for bladder leaking are considered to be the gold standard treatment.  You might be surprised that I would come out and say that confidently.  I can because there was a Joint Statement on Mesh slings published in 2022 (supported by 7 different organizations that are thought leaders in this field) that clearly stated this fact.  This is also what I see in my clinical practice.  So let me clear- a mesh sling is a safe and effective way to treat stress urinary incontinence.  But, it is not the best treatment for every woman.  Women who are opposed to mesh should not have mesh placed and should understand the risks and benefits of the surgery they are choosing.

Is the recovery fairly quick and easy?

Surgery is a trauma.  That is the truth.  Your body knows this and it takes time and energy to heal.  But mesh sling surgery has small incisions and generally has a quick recovery time (recognizing that every body is unique).  There is not much pain and the pain does not last long.  Fatigue can last for a few weeks.  I let my patients exercise 2 weeks after surgery (I even let someone run 17 miles 2 weeks after a surgery.  I was nervous, but she did great).  My patients often go back to work a few days after the surgery.

So, the lie?  Sling surgeries don’t work for all leaking, only stress incontinence.  Mesh slings are the gold standard but there are other options if you don’t like the idea of mesh.  And the recovery is usually fairly easy.

1. Joint position statement on midurethral slings for stress urinary incontinence. Neurourology and Urodynamics. 2022;41:31-34