A mid-urethral sling (MUS) is a common surgical procedure to treat stress urinary incontinence (SUI) in women. SUI involves the involuntary leakage of urine during activities that increase abdominal pressure, such as coughing, sneezing, or exercising. The MUS procedure involves placing a narrow strip of synthetic mesh, typically polypropylene, under the middle section of the urethra to provide support and prevent leakage. While generally effective, like any surgical intervention, mid-urethral sling placement carries the possibility of complications.
Immediate Post-Operative Complications
Following mid-urethral sling surgery, some patients may experience complications within the initial days or weeks. Urinary retention, characterized by difficulty emptying the bladder, is a recognized immediate issue. This can occur if the sling is placed with too much tension, obstructing urine flow.
Bladder irritation or overactivity, leading to frequent or urgent urination, can also develop shortly after the procedure. This “de novo urgency” is a type of lower urinary tract symptom (LUTS). Additionally, urinary tract infections (UTIs) are a common postoperative complication. These infections may arise due to catheterization during surgery or changes in bladder emptying patterns.
Delayed and Long-Term Complications
Complications from a mid-urethral sling can also manifest weeks, months, or even years after the initial surgery. Chronic pain, which can present in the groin, pelvis, or vagina, is a long-term concern. This pain may be related to nerve damage, scar tissue formation, or improper sling placement.
Mesh erosion or extrusion is another delayed complication, where the synthetic sling material protrudes into surrounding tissues such as the vagina, bladder, or urethra. This can occur due to factors like tissue reaction, infection, or excessive tension on the sling.
De novo urgency can also develop in the long term. Serious complications such as fistula formation, an abnormal connection between organs, or nerve damage can also occur.
Recognizing Signs and Symptoms
Patients should be aware of specific signs and symptoms that might indicate a developing complication after mid-urethral sling surgery. Persistent or worsening pain in the pelvic, groin, or vaginal areas that does not subside with typical recovery is a significant indicator. This pain might be especially noticeable during physical activity or intercourse.
Unusual vaginal discharge, bleeding, or the visible presence of mesh material in the vagina are direct signs of mesh erosion or extrusion. Difficulty urinating, a weakened urine stream, or the sensation of incomplete bladder emptying can signal an obstruction caused by the sling. New onset of urinary urgency or frequency, or recurrent urinary tract infections, can also point to issues like bladder irritation or obstruction. Any new or concerning symptoms should prompt communication with a healthcare provider for evaluation.
Diagnosis and Treatment Approaches
Healthcare professionals employ various methods to diagnose mid-urethral sling complications. A thorough physical examination, including a pelvic exam, helps assess for mesh exposure or tenderness. Imaging techniques such as ultrasound or MRI can visualize the sling’s position and identify abnormalities or fluid collections. Urodynamic studies, which measure bladder function, can help determine if there is an obstruction or new bladder overactivity.
Cystoscopy, a procedure involving a thin, lighted tube inserted into the urethra to view the bladder and urethra, is often performed to identify mesh erosion into the urinary tract. Urine tests detect infections or blood in the urine. Once a complication is diagnosed, treatment approaches vary based on the specific issue and its severity.
Conservative management may include medications to address bladder irritation or pain, or pelvic floor physical therapy to improve bladder function and reduce discomfort. For more severe complications, surgical interventions may be necessary. This can involve partial removal of the sling, especially for localized mesh erosion or pain, or complete sling removal if conservative treatments fail or if there is an infection or significant obstruction. Surgical repair of any damaged tissues, such as the bladder or urethra, may also be performed with sling removal.