Mid-Urethral Sling

The mid-urethral sling is implanted via an incision that supports the mid-urethral sphincter complex, essentially replacing the loss of support of the urethral pelvic ligaments. Overall, the sling is a more definitive and successful option than conservative management alone such as hormones or physical therapy. The sling is especially effective when the ligaments are so loose as to cause significant leakage.

Alternatively, you could choose a fascial sling, either autologous or cadaver. These biological slings are less effective and don’t last as long.

For the mesh slings, we expect at least 85% success rates with half of women getting completely dry and the other half getting significant improvement. Why everyone is not completely dry probably has to do with the degree of loss of estrogen or urethral scarring. We expect the sling to last for 10 to 20 years with a slow degradation in efficacy over time. We don’t have exact data because of the difficulty of following women over decades.

Insurance usually covers this surgery because it is a medical problem, not cosmetic.

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Mid-urethral or bladder slings are a better option than conservative measures like physical therapy or estrogen because they address one of the main problems causing the loss of urine; loss of urethra pelvic ligament support.

Slings work for patients who have a hypermobile urethra that demonstrates loss of ligament support.

We don’t know for sure how long a woman should expect her mid-urethral sling to last because it is difficult to conduct clinical trials over many decades. We do see some patients fail over the years. I usually tell patients that if they take care of their slings and avoid constipation, do their Kegel exercises and use low dose estrogen or annual MonaLisa Touch to maintain, then they should expect the sling to last for 10-15 years. Although that is anecdotal from my own patients’ experience.

Slings are considered medically necessary and elective so they ordinarily are covered by insurance and any out of pocket expenses are specific to your individual policy.

Insurance usually covers this surgery because it is a medical problem, not cosmetic.

Mid-urethral slings have really gotten a bad reputation because they are made of polypropylene mesh. The mesh problem has been on the top of minds as providers of Female Pelvic Medicine and Reconstructive surgery.

Most of the problems were caused by the larger sheets of mesh for pelvic organ prolapse. There have not been any recalls, but the FDA is now preventing companies from marketing the mesh. However, they are still offering mesh slings.

There has been lots of information about mesh online. For more information read refer to the FDA’s website and letter as that summarizes the state of affairs pretty well.

There are several safe and effective options using slings. Your doctor can review which approach would best for your specific condition.

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