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Midurethral Sling

A midurethral sling system is designed to inhibit urethral dropping during physical activity including laughing or lifting.

What You Need to Know

And How Advanced Gynecology Can Help

A midurethral sling procedure is designed to help women with stress incontinence. Stress incontinence is the loss of control of bladder function, or leakage under physical pressure. This can happen with everyday activities including coughing, sneezing or jumping. Stress incontinence affects up to one third of women at some point in their lives. It can range from a mild inconvenience for some to a persistent and severe disruption of daily activities.

The procedure is a minimally invasive technique that uses needles to place a narrow ribbon of mesh under the urethra. It takes from 15 to 30 minutes to perform and is typically done as an outpatient procedure using local anesthesia and a sedative drug administered intravenously.

Our board-certified team of women's health experts are ready to help you with diagnostic care and a range of treatment options. We will counsel you about the best options for you and your health.

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Why You Might Need Midurethral Sling

Stress urinary incontinence is a disorder of the pelvic floor. Pelvic floor disorders can occur when the tissues and muscles that support the urethra, bladder, uterus, or rectum are damaged. In the case of stress urinary incontinence, the muscle that controls the urethra is weakened causing it to leak. This may be an outcome of pregnancy, childbirth, or aging.

There are non-surgical treatments that may help stress incontinence including drinking less fluid, curbing caffeine intake, stopping smoking, and losing weight. Kegel exercises, (exercises to increase the strength of the pelvic floor muscles), physical therapy and biofeedback are all other non-surgical options to help with urinary stress incontinence.

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Different Types & Placements of Midurethral Slings

If you and your healthcare provider determine that a midurethral sling is your best option to treat your stress urinary incontinence, some other decisions must be made. There are two main types of midurethral synthetic procedures: retropubic and transobturator. The retropubic technique is the first procedure introduced to treat stress incontinence and is commonly referred to as TVT (tension-free vaginal tape).

Transobturator (TOT) was developed to minimize the potential for bladder injuries and is considered the safer of the two options to perform because unlike TVT, it avoids surgical movements between the pubic bone and the bladder. TOT and TVT are both types of slings made of polypropylene mesh, which stays in place without sutures and allows scar tissue to grow around and through it.

Cure rates for TVT range from 65-95% after 11 years. Long-range data for TOT is unavailable, but its short-term effectiveness has found to be similarly effective. Use of the mesh midurethral sling is supported by the American Urogynecologic Society and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction.

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Recovery & Possible Complications


During recovery, discomfort may last for a few days or weeks. You may be told to avoid any activity that might put stress on the surgical area, including:
  • Excessive straining
  • Strenuous exercise
  • Heavy lifting

Some patients may discover that it is more difficult to urinate after surgery or that urination is slower. Some find they may need to use a catheter during recovery.


In rare cases, the stitches or the sling itself may need to be adjusted or removed if voiding becomes too difficult. There are a few risks involved in midurethral sling procedures, as with all surgical procedures:
  • Injury to the bladder, bowel, blood vessels, or nerves
  • Bleeding Infection of the urinary tract
  • Difficulty urinating or other urinary problems
  • Complications resulting from anesthesia