For stress urinary incontinence, a bladder sling can give you the most long-term and reliable relief. However, after an in-dwelling sling surgery, a person can, within a period of many months or years after placement, developnew urinary, pelvic, vaginal or sexual problems. So if you had sling surgery in the past, and have, among other problems or complaints-the onset of pelvic pain or painful intercourse or problems emptying your bladder or a new or increased amount of leaking, or unusual vaginal symptoms-it is reasonable for you to ask if your sling is implicated in your problems.
The answer to this question does not come from a simple yes or no. Slings may be in place without issues for years and the subsequent development of symptoms could be attributed to other factors including a change in tissues as a result of menopause or pelvic floor dysfunction; recurrent urinary incontinence; urinary tract issues; or some other pelvic problem. On the other hand, other sling complications may develop with subsequent examinations being warranted.
The type of sling used for your original surgery should be considered as modern mesh slings placed in midurethra are not the same as old tapes/slings; each carry their own risks and there are studies of very large numbers of patients who have long-term data reported for them.
What Is a Bladder Sling?
Bladder sling- surgical treatment for stress urinary incontinence, or the leakage that is triggered by actions such as coughing, laughing, sneezing, exercise, or lifting, which causes increased pressure on your bladder.
When considering bladder sling complications years later, a common approach is a midurethral sling. The sling provides support beneath the urethra so it can better resist pressure during physical activity. Many slings use synthetic mesh, although other sling materials and surgical techniques are available.
The term “bladder sling” can be misleading because the sling is generally placed beneath the urethra rather than directly around the bladder.
Why are slings used?
Stress urinary incontinence may be caused when the muscle support of the urethra is ineffective. Childbirth and delivery, aging, Pelvic surgery and failure of pelvic support may lead to the condition being worsened.
The point of placing a sling is to increase support to the urethra, rather than to operate upon the bladder.
The operation can be effective and complications may arise as with all surgery.The FDA states complications may involve a vaginal mesh being migrated (vaginal mesh erosion), Urinary complications, Pain, additional surgery as outlined in FDA guidance on surgical mesh used for stress urinary incontinence.
What Complications Can Develop Years Later?
Long-term symptoms can vary considerably. Some are directly related to the sling or surrounding scar tissue, while others may reflect a recurrence of the original condition or an unrelated pelvic problem.
1. Vaginal mesh exposure or erosion
One of the most recognized mesh-related complications is vaginal mesh exposure, sometimes called erosion or extrusion.
One possible issue when considering bladder sling complications years later is when part of the mesh becomes visible through the vaginal tissue. Vaginal irritation, bleeding, discharge, discomfort or pain when having sex may develop. However some cases were diagnosed before there was a noticeable development of symptoms by means of a routine pelvic exam. The FDA has acknowledged that erosion of vaginal mesh can develop after the surgical use of vaginal mesh slings and suggests that a second surgery might sometimes be warranted.
Importantly, FDA claims exposure to mesh does not need to be identified relatively soon after the surgical mesh sling operation was performed; indeed cases have been reported in FDA adverse-event reports, ofmesh problems occurring a number of years after implantation.
It is noted that FDA reports represent single cases; these cannot determine a rate of complication in the population at large.
2. Pelvic or vaginal pain
Any old pain which suddenly reappears and you notice is occurring about the area of the sling needs investigating. It could be due to scar formation around the mesh, or the mesh protruding out through the tissues, undue tightness around surrounding tissues, inflammation, damage to a nerve or just a separate issue within the pelvis itself. You may perceive the pain as ache, pressure, burning, tugging, or be sore over a sensitive area or on movement. Pain does not necessarily prove the sling is causing the problem – a pelvic examination often identifies whether the problem lies in the mesh, scar tissue, muscles or elsewhere.
3. Painful intercourse
Possible reasons that painful sex (dyspareunia) occurs years after a well tolerated pelvic surgery. A change in the vaginal tissues, pelvic floor muscle tension, dryness of the vagina associated with post-menopause, scar tissue, mesh exposure and any other gynecological reasons are possible if symptoms have started a couple of years after surgery. Mesh problems do happen, but are not always what is responsible. A clinician can perform a visual inspection of the vaginal tissues and determine whether there is tenderness directly over the sling or surrounding scar tissue.
4. Difficulty emptying the bladder
A person may develop problem beginning urination, thin stream, difficulty finishing voiding, and feeling that bladder has not emptied.
Too much resistance below the urethra provided by the sling itself can result in obstruction and Urinary retention. Too tight of sling is known possible complication of sling placement.
When considering bladder sling complications years later, these symptoms may have causes unrelated to the original surgery. Pelvic organ prolapse, medications, neurologic conditions, urinary tract problems, and changes in bladder function can all affect how well the bladder empties.
5. New urgency or urge incontinence
Slings are mostly designed for stress leakage. Urge incontinence, an issue with urgency that is strong and cannot be voluntarily inhibited when the leak occurs, isn’t necessarily an issue slung. De novo urgency has been reported in some patients following sling surgery.
FDA follow up for some sling systems have noted de novo urgency at long-term follow-up.
When urgency develops at many years post-sling procedure, a relationship between the sling and subsequent urgency is not confirmed. Overactive bladder, bladder infections, changes in menopause, inflammation of the bladder and more will have urgency and may mimic this problem.
6. Recurrent stress incontinence
Another long-term complication would be the recurrence of initial leak.
Support using slings can become worn over time, and the way the support structure is attached to surrounding tissues of the urethra could be altered by changes within the pelvic tissue. Conditions such as changing body weight, aging, menopause, history of pelvic surgery and other conditions affecting the pelvis would also contribute to symptoms. Recurrence of leakage does not necessarily mean that the sling is wearing or is otherwise damaged.
Why Can Symptoms Appear Years After Surgery?
The timing of a complication can be confusing. If recovery was normal for several years, why would a problem suddenly appear?
There are several possible explanations.
Tissue changes over time
The tissues surrounding an implanted sling continue to change. Scar tissue can mature, vaginal tissues can become thinner, and hormonal changes can affect tissue strength and moisture.
After menopause, declining estrogen levels can contribute to vaginal dryness and tissue fragility. These changes can make previously unnoticed mesh exposure more symptomatic.
Changes in the sling or surrounding scar tissue
An implanted mesh sling does not exist in isolation. It becomes incorporated into surrounding tissue.
Over time, changes in scar tissue, tension, tissue thickness, or local inflammation can alter how the area feels. A problem may therefore become noticeable long after the original procedure.
Aging and pelvic floor changes
The pelvic floor changes throughout life. Aging, menopause, childbirth history, changes in body weight, constipation, chronic coughing, and physical strain can all influence pelvic support.
Consequently, new symptoms do not automatically mean that the original operation was unsuccessful.
Another condition may be responsible
Urinary symptoms can come from many sources.
When considering bladder sling complications years later, it is important to remember that symptoms can have different causes. For example, urgency may result from an overactive bladder, while burning urination may indicate a urinary tract infection. Pelvic pain may be related to muscles, nerves, reproductive organs, bowel conditions, or the urinary system.
That is why diagnosing the specific cause is more useful than assuming that every new symptom is a sling complication.
Symptoms That Should Not Be Ignored
A person who had a sling years ago should consider medical evaluation for new or persistent symptoms such as:
- New pelvic or vaginal pain
- Pain during intercourse
- Vaginal bleeding unrelated to an expected menstrual period
- Unusual vaginal discharge
- A rough or firm area felt inside the vagina
- Recurrent stress incontinence
- New urinary urgency or frequency
- Difficulty starting urination
- Weak urinary stream
- A feeling of incomplete bladder emptying
- Recurrent urinary tract infections
- Blood in the urine
- Symptoms that progressively worsen
These symptoms do not automatically indicate mesh failure. They simply justify an evaluation to determine what is happening.
How Doctors Evaluate Possible Sling Complications
There is no single test that can identify every sling-related problem. Evaluation generally begins with a detailed history and physical examination.
Step 1: Review the original surgery
If possible, bring information about the original procedure. The surgical report can identify the type of sling, its location, and whether any complications occurred during the operation.
This information can be particularly useful if the surgery occurred many years ago.
Step 2: Describe the symptom pattern
Tell the clinician exactly when the problem began and how it has changed.
For example, explain whether pain occurs constantly or only during intercourse, whether urinary leakage happens with coughing or urgency, and whether difficulty urinating occurs every time or only occasionally.
The pattern can provide important diagnostic clues.
Step 3: Have a pelvic examination
A pelvic examination can help identify vaginal mesh exposure, tenderness, scar tissue, tissue thinning, pelvic organ prolapse, or other abnormalities.
If mesh is exposed, the clinician may be able to see or feel it during examination.
Step 4: Evaluate bladder emptying
If incomplete emptying is suspected, a clinician may measure post-void residual urine, which determines how much urine remains in the bladder after urination.
Additional urine testing may be appropriate when infection or blood in the urine is suspected.
Step 5: Consider specialized testing
Other investigations can then follow as needed and based on your symptoms which may be a cystoscopy, imagery, urodynamic studies and other investigations.
Cystoscopy: This involves having a thin telescope to visually look at the inside of the urethra and bladder. It will be suggested if an investigation of the bladder and urethra are considered to be necessary, or another possible problem has been thought about.
It will not be necessary for everybody to have all of these tests and they will be considered relevant to your examination and symptoms.
How Are Late Sling Complications Treated?
Treatment depends entirely on the underlying problem and women’s urinary health and pelvic floor care can provide useful context when considering symptoms and treatment options.
Mild vaginal exposure
A small, asymptomatic area of exposure may sometimes be monitored or treated conservatively, depending on its size, location, tissue condition, and symptoms.
Vaginal estrogen may be considered in some postmenopausal patients with vaginal tissue thinning, but it should be recommended by a clinician who has evaluated the individual situation.
Pain or scar-related problems
If pain is caused by pelvic floor muscle tension, physical therapy may help. If a focal mesh or scar problem is identified, treatment may be more targeted.
The goal is to determine whether removing or modifying the sling is actually likely to improve symptoms.
Urinary obstruction
When a sling is causing significant obstruction or retention, a specialist may consider procedures to loosen, divide, or remove part of the sling.
This requires careful decision-making because treating obstruction can potentially cause stress incontinence to return.
Mesh exposure or erosion
Treatment will vary on level of exposure, and could involve simply watching the condition, treated either locally, or with local partial mesh excision or full surgical excision. The FDA state that mesh erosion can lead to re-intervention in the operating room; mesh removal however can be quite extensive and be complicated by adhesions that make dissection difficult, as well as possible complications of “complete’ removal itself.
Recurrent stress incontinence
If the original leakage returns, treatment options may include pelvic floor therapy, behavioral strategies, continence devices, medications for selected symptoms, or another surgical approach.
A specialist should evaluate the reason for recurrence before another operation is chosen.
Does Sling Removal Fix All Symptoms?
Not necessarily.
This is very relevant to the patient contemplating this operation. Though removing a mesh sling may be needed if it is causing complications that may be directly attributed to the device; that does not mean that all symptoms will resolve.
Pain can be Multifactorial; scar tissue will be present post mesh removal, and indeed, the operation may introduce newscar.
This surgery also has the potential for return of stress incontinence because the support mechanism that is effectively closing off leakage has been lessened through the division or removal process of the mesh sling.
Therefore, this should be carefully assessed through discussion of expectations, risks, and alternatives.
Common Mistakes People Make
Assuming every symptom is caused by the sling
A prior sling is an obvious feature in a patient’s history, but it is not necessarily the explanation for every pelvic symptom.
A urinary infection, menopause-related tissue change, pelvic floor dysfunction, overactive bladder, prolapse, or another medical condition can look similar.
Waiting because the surgery was years ago
The age of the implant does not mean new symptoms should be ignored.
Some device-related problems can become apparent later, and new symptoms deserve evaluation regardless of how long ago the surgery occurred.
Assuming removal is always the best solution
Removal is a surgical procedure with associated risks. It may be necessary for certain types of complications and totally unnecessary when symptoms are from unrelated processes. A second opinion, usually by a urogynecologist or another surgeon who deals with sling complications, is indicated in certain situations of diagnostic or therapeutic uncertainty.
Treating recurrent leakage without identifying the type
Stress leakage and urge leakage are different problems.
A person can also have mixed urinary incontinence, meaning both conditions occur. Correctly identifying the type of leakage helps determine which treatment is most likely to help.
When Should You See a Urogynecologist?
Urogynaecologists perform female pelvic medicine and reconstructive surgery. They may assess urinary incontinence, pelvic organ prolapse, pelvic pain, as well as any problem resulting from prior pelvic surgery. Specialist assessment should be considered if there is persistent unexplained symptoms or if the cause is thought to be associated with your originalsling.
A specialist assessment is particularly useful if another operation has been recommended; as this revision surgery can be more complicated than original placing of the sling.
If you have major urinary retention, significant bleeding, fever with pelvic pain, can’t empty bladder or have progressive deteriorations please get medical attention immediately and do not wait for a scheduled appointment.
What Information Should You Bring to Your Appointment?
Certain details can help optimize the assessment.
Please bring, if readily available or send ahead if you have one, your original operative report including the estimated date of the surgery, and an estimate of the surgical indications and complications that you remember. It may also be useful for you to keep a log of your symptoms including location and characteristics of your pain and urinary symptoms, things that alleviate or aggravate symptoms, whether leakage is with urgency, strain and if coitus brings on pain.
Please also bring any operative reports of previous cystoscopy, imaging, urine studies and pelvic examination. The ultimate aim is to enable the specialists to differentiate between potential sling- related problems, from potentially distinct pelvic or urinary problems.
Long-Term Outlook After Bladder Sling Surgery
Many women have a sling procedure for many years with no adverse events. The possibility of later complications doesn’t necessarily mean that a sling will cause a problem eventually.
The FDA’s review of randomized trials revealed that mini-slings had clinical performance equivalent to midurethral slings through 5 years in terms of similar adverse events and re-operation.
Concurrent symptoms of late occurrence are possible and appropriate work-up is merited. Stated complications include vaginal mesh erosions, pain, voiding difficulties, voiding symptoms, recurring incontinence, and dyspareunia.
It may be equally inaccurate not to expect problems but to attribute all symptoms to the sling. A thorough assessment integrating symptoms, examination, the type of sling used, and details regarding the prior surgical intervention is essential.
Final Takeaway
Bladder sling complications years later can include vaginal mesh exposure, pelvic or vaginal pain, painful intercourse, difficulty emptying the bladder, new urinary urgency, recurrent infections, or return of stress incontinence. These symptoms can sometimes be related to the sling, but they can also result from menopause, pelvic floor dysfunction, urinary conditions, prolapse, or other causes.
One should be cautious to attribute a symptom that develops years post-operatively to the implant, yet one should certainly not dismiss it outright. Pelvic examination and bladder testing (or further studies if needed) will reveal the etiology. Treatment varies and can involve watchful waiting, conservative management, or revision or removal in select patients. Treatment choices are best made in conjunction with an experienced female pelvic medicine physician.
Frequently Asked Questions
1.Can bladder sling complications occur years later?
Yes. Although many people continue to do well after sling surgery, some complications or new symptoms can become apparent months or years later. Possible problems include mesh exposure, pelvic pain, painful intercourse, urinary obstruction, recurrent incontinence, and other urinary symptoms. The FDA recognizes erosion, pain, urinary problems, and the possibility of additional surgery as potential complications of mesh sling procedures.
2.What are the most common bladder sling complications years later?
Possible long-term problems include vaginal mesh exposure or erosion, pelvic or vaginal pain, pain during intercourse, difficulty emptying the bladder, urinary urgency, recurrent urinary tract problems, and return of stress urinary incontinence. Not every new symptom is caused by the sling, so an examination is important before assuming the implant is responsible.
3.Can a bladder sling cause pelvic pain years later?
It can be associated with pelvic or vaginal pain, although pain can have many other causes. Scar tissue, mesh exposure, tissue changes, pelvic floor muscle problems, and other gynecologic or urinary conditions may produce similar symptoms. Persistent or newly developing pelvic pain should be evaluated by a healthcare professional.
4.Can a bladder sling cause painful intercourse years later?
Yes, painful intercourse can occur in association with sling or mesh complications. Vaginal mesh exposure, scar tissue, pelvic floor muscle tension, vaginal dryness, and other conditions can contribute. The FDA includes painful intercourse among complications evaluated in long-term follow-up of some sling devices.
5.Can a bladder sling cause difficulty urinating years later?
Difficulty starting urination, a weak stream, or a feeling of incomplete emptying can occur after sling surgery. A sling that creates excessive resistance around the urethra can contribute to urinary obstruction, but new urinary difficulty years later can also have unrelated causes. A clinician may measure the amount of urine remaining in the bladder after urination to investigate the problem.
6.Can a bladder sling stop working after several years?
Yes. Stress urinary incontinence can return after sling surgery. Recurrent leakage does not necessarily mean the sling has broken or moved. Changes in pelvic tissues, aging, weight changes, or other pelvic floor conditions can affect continence over time. Long-term follow-up studies have documented recurrent incontinence and additional procedures in some patients.
7.What does vaginal mesh exposure feel like?
Some people have no symptoms and the exposure is discovered during a pelvic examination. Others may experience vaginal irritation, unusual discharge, bleeding, pelvic discomfort, or pain during intercourse. An implanted sling can develop tissue-related changes over time and long-term complications of midurethral sling surgery can help explain why certain symptoms may appear years after the original procedure.
Conclusion
Bladder sling complications years later can include vaginal mesh exposure, pelvic or vaginal pain, painful intercourse, urinary difficulties, recurrent leakage, and other changes in bladder function. Although these problems can occur, a new symptom years after surgery does not automatically mean the sling is responsible. Aging, menopause, pelvic floor dysfunction, urinary conditions, and other gynecologic problems can produce similar symptoms.
Persistent or a new condition warrants further communication with a physician if associated with pain, bleeding, discharge, problems with urine flow or changing levels of bladder control. FDA encourages seeking a physician follow up for any new symptoms presenting post sling surgery. There are specific bladder tests, pelvic exams and imaging procedures to determine the real issue, and if complicated by the sling, the management is divided into conservative treatment or revision/removal in selected individuals. Revision procedures have a distinct risk and an expert urogynecologist is necessary for planning management.
