Bladder and Urethral Slings
Bladder and urethral sling surgeries are used to treat urinary incontinence that cannot be successfully treated with medication. A surgeon uses your own tissue, strips of synthetic mesh or animal or donor tissue to create a sling under your urethra or bladder neck. The sling supports the urethra and helps keep it closed to prevent urine leakage.
Types of sling procedure
- Tension-free sling. No stitches are used to attach a tension-free sling. Instead, body tissue holds the sling (which is made from a strip of synthetic mesh tape) in place. Scar tissue eventually forms around the mesh and keeps it from moving.
There are three approaches for a tension-free sling procedure:
- Retropubic. A surgeon makes a small incision inside the vagina and two small opening above the pubic bone just big enough for a needle to pass through.
- Transobturator. A surgeon makes an incision similarly in the vagina, but also creates a small opening on each side of the labia for a needle to pass through.
- Single-incision mini. A surgeon only one small incision in the vagina to perform the procedure.
- Conventional sling. A surgeon makes an incision in the vagina and places a sling made from synthetic mesh tape, your own tissue or tissue from an animal or deceased donor under the neck of the bladder. The sling is pulled through another incision in the abdomen to adjust tension. Each end of the sling is then attached to fascia (pelvic tissue) of the abdominal wall using stitches. This type of surgery can require a larger incision than a tension-sling.
Who is a good candidate for sling surgery?
The typical patient has moderate to severe urinary incontinence where the cause of the problem is known and the problem has not been alleviated by less invasive options such as medications and physical therapy.
A bladder fistula is an abnormal connection between the bladder and another organ or skin. The most common forms of bladder fistulas involve:
- The bowel (enterovesical fistula)
- The vagina (vesiovaginal fistula)
Although relatively rare, fistulization to the skin can result from an injury or previous surgery in the face of bladder outlet obstruction.
The biggest issue with fistulas is that they are created by infection, and they carry this infection to any organ they connect to. For example, if it tunnels out and connects to the bladder, a bladder infection can devlop.
Who is at risk for developing a bladder fistula?
- The most common reason for a bladder fistula is an inflammatory bowel disease, such as Crohn’s Disease or diverticulitis. Around 25% of people with Crohn’s Disease will develop a fistula.
- Approximately 20% of bowel fistulas are caused by bowel cancer.
- Fistulas may also develop as a result of previous radiation therapy.
- Inflammation of the lining of the digestive tract causes the intestines to form scar tissue and become abnormally thick.
- This thickening can lead to the formation of ulcers on the inside lining of the intestines.
- When the ulcers grow deeper, they can begin to burrow through the wall of the intestine, forming a tunnel that leads to whatever tissue is next to the sore.
Anal abscesses are often linked with fistulas and result from infection of the small glands inside the anus. Crohn’s disease increases the risk of infection of these glands.
Common symptoms of bladder fistula include:
- Frequent urinary tract infections
- Passage of gas from the urethra during urination
- Urinary leakage
A doctor may administer the following tests to diagnose a bladder fistula:
- Excretory urogram.- an x-ray examination of the bladder in which contrast dye is injected into the patient’s system and its progress through the urinary tract is recorded to study the anatomy and function of the bladder and urinary tract.
- CT Scan
- Cystogram (bladder x-ray)