Sling surgery for stress incontinence: tape procedures, risks and recovery

Stress incontinence is leaking triggered by effort, such as coughing, sneezing, jumping or lifting, because the urethra and its support are not holding against the pressure. It is different from urge incontinence, where a sudden strong need to pass urine causes leakage, and the two are treated differently. A bladder test may be needed first if the type is unclear.

Surgery is normally not the first step. The NHS lists lifestyle changes such as adjusting caffeine and fluids and losing weight where relevant, pelvic floor training with a minimum of 8 muscle contractions at least 3 times a day continued for at least 3 months, and in some cases duloxetine, a medicine that raises urethral muscle tone. The Worcestershire leaflet likewise names pelvic floor exercises as first-line care, with biofeedback, electrical stimulation, medicines or hormone therapy as other steps.

If you are planning more children, surgeons often advise waiting, since pregnancy and birth can undo the effect.

The East Sussex leaflet describes a thin, soft nylon mesh tape that acts as a hammock beneath the urethra and is held in place by scar tissue. Two routes exist. In one the tape passes behind the pubic bone and exits through small cuts above it; in the other, the transobturator route, it passes through the hip bone space and exits in the groin creases.

Other operations exist, including bulking injections and colposuspension, but they are outside the leaflets used for this page. Mesh used in prolapse surgery has been restricted in the NHS, and mesh tape for incontinence has been the subject of national safety reviews, so ask your surgeon about the type, the evidence and the alternatives that use your own tissue.

Assessment usually includes a bladder diary, a urine test and sometimes urodynamic testing, which measures pressure and flow. These tests confirm that the leakage is stress type and that the bladder empties well, which affects both the choice of operation and the risk of problems after it.

Your anaesthetic is chosen with you: the leaflet describes general anaesthetic or local anaesthetic with sedation, and spinal when combined with other surgery. Follow hospital fasting instructions and take care of any urine infection beforehand.

• Stop smoking if you can, to help healing and reduce chest and coughing problems.

• Treat constipation and a chronic cough, which strain the repair.

• Arrange a lift home and someone to help with lifting for a few weeks.

The Worcestershire leaflet describes a ribbon-like strip of mesh inserted under the urethra through a small vaginal cut and two small cuts in the lower abdomen, with a cystoscopy, a look inside the bladder, to check position. It takes less than 30 minutes when done alone, and most women go home the same day. A catheter is usually used only after spinal or general anaesthetic or when other surgery is combined, and is removed when you are ready to get out of bed.

You will be asked about passing urine before discharge, since a bladder that does not empty properly is an early problem. Walking soon afterwards is encouraged.

The Worcestershire leaflet says 8 out of every 10 women are cured or significantly improved and that 9 out of 10 are satisfied. It lists failure to improve in 2 in 10, new urgency or frequency in 1 in 20, bladder perforation in fewer than 1 in 50, chronic pain in 2 to 3 per 100 and mesh erosion in 1 in 100. Figures differ between trusts and studies, so ask your surgeon for their own audit.

Other possible problems are trouble emptying the bladder, bladder infection, bleeding, pain during sex and a need for later surgery to loosen or remove the tape. Because tape is permanent, those matters deserve careful discussion before consent.

The leaflet advises avoiding strenuous exercise and heavy lifting for up to four weeks, avoiding sex for four weeks, taking two weeks off work and not driving for at least one week. Mild vaginal discharge and some groin soreness are expected. Drink normally, avoid constipation and continue pelvic floor exercises as your physiotherapist advises.

The ability to drive depends on being comfortable enough to make an emergency stop. GOV.UK says the DVLA must be told if you are still unable to drive three months after an operation, and your insurer may have its own terms.

• Heavy bleeding that is not a period, or an unpleasant vaginal discharge.

• Burning when passing urine, or an urgent need to pass urine that persists.

• Being unable to pass urine at all: seek urgent help.

• A swollen calf, chest pain or breathlessness: 999 if severe.

• Which type of tape will you use, and is an alternative that uses my own tissue suitable?

• How many of these operations do you perform, and what are your results?

• What is the chance that I will have trouble emptying my bladder?

• What happens if the tape needs to be removed?

Both settings offer the same tape operations, but NHS units usually expect pelvic floor training to have been tried and documented, and may require specialist assessment such as urodynamics. Private care may be quicker to arrange; ask whether the surgeon contributes to a national register of tape procedures and who handles complications after discharge.