Mid-urethral sling reduces incontinence after prolapse surgery

Patients who receive a mid-urethral sling have less than half the risk of urinary incontinence after prolapse surgery than those who do not receive a sling, according to a recent study.

Researchers at the University of Michigan Health System, Ann Arbor and other institutions in the Pelvic Floor Disorders Network assigned 337 patients presenting with vaginal prolapse repair between May 2007 and October 2009 with either a mid-urethral sling or sham incisions. The authors tested women preoperatively for urine leakage during coughing or straining. They followed up at 3 and 12 months with a cough stress test, urinalysis, and post-void residual measurements.

Inserting a sling at the time of the surgery resulted in less urine leakage 3 and 12 months later, the authors reported in the New England Journal of Medicine (2012; 366:2358-67). However, patients with slings experienced higher rates of expected adverse events, including incomplete bladder emptying, urinary tract infection, bladder perforation, and bleeding.

"This gives doctors more data to counsel their patient and gives patients more concrete information on which to base treatment decisions," said lead author John T. Wei, MD, of the University of Michigan.

"This is not saying that you have to use a sling, but a doctor can now inform women that if they don’t put in a sling at the time of vaginal bladder prolapse surgery, 49% of the time they will experience urine leakage 3 months afterwards compared with a 23% chance of leakage with the sling. On the other hand, with the sling, there is a slightly higher chance of side effects."

The trial was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institutes of Health Office of Research on Women’s Health.

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