Urinary Incontinence Surgery: Do You Need a Sling? Understanding Mesh, Non-Mesh Options, and What Every Woman Should Know

Considering Surgery for Urinary Incontinence?

If you’ve been diagnosed with stress urinary incontinence (SUI), you’ve probably come across terms like midurethral sling, mesh sling, bladder sling, and mesh complications. Unfortunately, the amount of conflicting information online can make it difficult to know what to believe.

Some women are told a sling is the gold standard for treating stress urinary incontinence, while others worry about reports of mesh-related complications. The reality is more nuanced.

For many women, a sling procedure provides excellent long-term relief from urine leakage. For others, a non-mesh option—or even avoiding surgery altogether—may be the better choice. The key is understanding your diagnosis, learning about all available treatments, and working with a surgeon experienced in both primary incontinence surgery and the management of complications.

What Is Stress Urinary Incontinence?

Stress urinary incontinence occurs when physical activity places pressure on the bladder and urine leaks because the urethra is no longer adequately supported.

Women commonly leak urine when they:

• Cough
• Sneeze
• Laugh
• Exercise
• Run
• Jump
• Lift heavy objects

This condition often develops after pregnancy, childbirth, menopause, aging, or previous pelvic surgery.

Unlike overactive bladder, stress urinary incontinence is not caused by a sudden urge to urinate. Instead, it results from weakened support of the urethra and pelvic floor.

What Is a Midurethral Sling?

A midurethral sling is one of the most commonly performed surgeries for stress urinary incontinence. During the procedure, a narrow strip of material is placed beneath the urethra to provide support during activities that increase abdominal pressure.

The sling acts like a hammock, helping the urethra remain closed when you cough, laugh, or exercise.

Depending on the patient’s condition, a sling may be made from:

• Synthetic mesh
• Your own tissue (autologous fascial sling)

Each option has advantages, limitations, and potential risks.

Are Mesh Slings Safe?

This is one of the most frequently asked questions—and one that deserves a balanced answer.

For many women, synthetic midurethral slings have been studied extensively and have demonstrated high success rates for treating stress urinary incontinence. Many patients experience years of improved bladder control and are satisfied with their outcomes.

However, like all surgical procedures, complications can occur. While most women do not experience serious problems, it is important to understand the potential risks before making a treatment decision.

An informed discussion with your surgeon should include both the benefits and the possible complications.

Possible Mesh Sling Complications

Although uncommon, complications may include:

• Persistent pelvic pain
• Pain during intercourse (dyspareunia)
• Mesh exposure or erosion into the vagina
• Urinary retention or difficulty emptying the bladder
• New or worsening urgency symptoms
• Recurrent urinary tract infections
• Bladder or urethral injury
• Continued urine leakage despite surgery

The likelihood of these complications varies based on the individual patient, surgical technique, and other factors.

Does the FDA Ban Mesh Slings?

This is an area that often causes confusion.

The FDA ordered manufacturers to stop selling transvaginal mesh products designed specifically for pelvic organ prolapse repair in 2019 because manufacturers did not demonstrate reasonable assurance of safety and effectiveness for those devices.

That action did not ban midurethral slings used to treat stress urinary incontinence.

Midurethral slings remain available and continue to be used for appropriately selected patients.

Understanding the difference between prolapse mesh and incontinence slings is important because they are different devices used for different conditions.

What Are the Alternatives to a Mesh Sling?

Not every woman needs—or wants—a synthetic mesh sling.

Depending on your diagnosis, alternatives may include:

Pelvic Floor Physical Therapy

Strengthening the pelvic floor may improve mild stress urinary incontinence, particularly when symptoms are caught early.

Lifestyle Modifications

Weight loss, smoking cessation, managing chronic cough, and treating constipation may reduce pressure on the pelvic floor.

Pessary

Some women benefit from a pessary that provides support to the bladder neck and pelvic organs.

Urethral Bulking Injections

Injectable materials can help improve urethral closure in selected patients, although results may not be as durable as surgery.

Autologous Fascial Sling

Instead of synthetic mesh, this procedure uses the patient’s own tissue to create the sling.

Because it requires harvesting tissue, recovery may differ from synthetic sling surgery.

What If I’ve Already Had a Sling and Still Leak?

Persistent or recurrent urinary leakage does not necessarily mean the original surgery “failed.”

Several possibilities may explain ongoing symptoms, including:

• Incorrect diagnosis
• Mixed urinary incontinence
• Overactive bladder
• Sling positioning
• New pelvic organ prolapse
• Weak pelvic floor support
• Progressive changes over time

A careful evaluation is needed before deciding whether additional treatment is appropriate.

What If I’m Having Problems After Mesh Sling Surgery?

Women experiencing complications after sling surgery may notice:

• Chronic pelvic pain
• Pain with intimacy
• Difficulty urinating
• Recurrent urinary tract infections
• Persistent urinary leakage
• Vaginal bleeding
• Feeling exposed mesh

These symptoms deserve prompt evaluation. The appropriate treatment depends on the underlying cause and may range from conservative management to revision or removal of part of the sling in selected cases.

Why Experience Is Especially Important in Sling Revision Surgery

Revision surgery following a previous sling procedure can be significantly more complex than the original operation.

Scar tissue, changes in anatomy, persistent incontinence, pelvic pain, and associated prolapse often require a comprehensive evaluation before deciding on the next step. In some women, symptoms may not be caused by the sling at all, making an accurate diagnosis essential before considering additional surgery.

Drs. John Miklos and Robert Moore have extensive experience evaluating women with both primary urinary incontinence and complications following previous pelvic floor procedures. Because they also treat pelvic organ prolapse, recurrent incontinence, and complex pelvic floor disorders, they are able to assess how all aspects of the pelvic floor work together before recommending treatment. Their goal is to identify the true source of a patient’s symptoms and recommend the least invasive option that is likely to provide meaningful improvement.

Make an Informed Decision About Your Treatment

Choosing surgery for urinary incontinence is a personal decision that should be based on a clear understanding of your diagnosis, your treatment goals, and the benefits and risks of each available option.

Whether you’re considering your first sling procedure, exploring non-mesh alternatives, or seeking answers after previous surgery, an individualized evaluation can help you make an informed choice with confidence.

Frequently Asked Questions

What is a bladder sling?

A bladder sling, also called a midurethral sling, is a procedure that supports the urethra to reduce urine leakage caused by stress urinary incontinence.

Is mesh used in all sling surgeries?

No. Some slings are made from synthetic mesh, while others use the patient’s own tissue (autologous fascial sling).

Did the FDA ban mesh slings?

No. The FDA’s 2019 action applied to certain transvaginal mesh products used for pelvic organ prolapse repair—not to midurethral slings used for stress urinary incontinence.

What are the symptoms of mesh sling complications?

Possible symptoms include pelvic pain, pain during intercourse, difficulty urinating, recurrent urinary tract infections, vaginal mesh exposure, and continued urinary leakage. These symptoms should be evaluated by a qualified pelvic floor specialist.

Can a failed bladder sling be repaired?

Yes. Depending on the cause of persistent symptoms, treatment may include pelvic floor therapy, medication, urethral bulking, sling revision, sling removal, or another reconstructive procedure.

Why should I see a specialist before having sling revision surgery?

Revision surgery is often more complex than the original procedure. A specialist can determine whether your symptoms are truly related to the sling, another pelvic floor disorder, or an entirely different condition before recommending additional surgery.