Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed May 14, 2026
What is a bladder sling procedure?
A bladder sling, more precisely called a midurethral sling, is a short outpatient surgery for stress urinary incontinence. I place a thin strip of supportive material underneath your urethra to rebuild the support that weakened over time. It is the most studied anti-incontinence procedure in history, with more than 3.6 million placed worldwide and objective cure rates of about 77 to 81 percent at one to two years.
How it works
During the procedure, a small polypropylene mesh tape goes under the mid-urethra through tiny incisions. The sling works like a hammock. When you cough, sneeze, or jump, it gives your urethra the backstop it needs to stay closed. It restores the mechanical support that was lost from childbirth, aging, or other factors.
The surgery takes about 30 minutes. You go home the same day.
There are two main approaches. In a retropubic sling, the tape passes behind the pubic bone. In a transobturator sling, it passes through the inner thigh. Both have similar cure rates. The retropubic route may be slightly more effective long-term, while the transobturator route has fewer serious complications. I help you decide which approach fits your anatomy and goals.
This is not the same as mesh for prolapse
You may have heard concerns about “mesh” in pelvic surgery. The midurethral sling is a narrow strip of mesh placed under the urethra for incontinence. It is fundamentally different from the large sheets of transvaginal mesh that were used for prolapse repair and led to FDA action in 2019. The FDA has not recalled or warned against midurethral slings. Eight major medical organizations, including the AUA, ACOG, and AUGS, continue to endorse their safety and effectiveness. Type 1 polypropylene mesh has demonstrated durability up to 17 years.
Recovery
Most women are back to their normal routine within a few weeks. I tell patients to let their body be their guide. If it hurts, don’t do it. Full healing takes about six weeks.
The most common short-term issue is temporary difficulty emptying the bladder. This happens in roughly 3 to 5 percent of patients and usually resolves on its own within a few weeks. Vaginal mesh exposure is uncommon, occurring in about 2 percent of cases.
Who is a candidate?
A sling may make sense if you have stress incontinence that bothers you and you want a durable fix. Not every patient needs surgery, though. We talk through your options together and find the approach that fits your life.
If you prefer to avoid mesh, urethral bulking is an office-based alternative. It uses an injectable material placed under the urethra through a small scope. Cure rates are lower (around 20 to 30 percent), but the procedure is less invasive and can be done under local anesthesia. It is a particularly good option for older adults, people on blood thinners, or anyone who wants to avoid surgery.
Other options include pelvic floor physical therapy and continence pessaries. We have in-office pelvic floor physical therapists who work with patients throughout the process, whether you choose conservative care or are getting ready for surgery.
The right choice depends on how much your symptoms bother you, your health, and what matters most to you. I have had patients tell me they forgot what it was like to sneeze without worrying.
References
- Richter HE et al. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010;362(22):2066-2076. doi:10.1056/NEJMoa0912658
- Albo ME et al. Treatment success of retropubic and transobturator midurethral slings at 24 months. J Urol. 2012;188(6):2281-2287. doi:10.1016/j.juro.2012.07.103
- AUGS-SUFU Joint Position Statement on midurethral slings for stress urinary incontinence. Female Pelvic Med Reconstr Surg. 2021;27(12):707-711. doi:10.1097/SPV.0000000000001096
- Kobashi KC et al. Surgical treatment of female stress urinary incontinence: AUA/SUFU guideline. J Urol. 2017;198(4):875-883. doi:10.1016/j.juro.2017.06.061
- Wu JM. Stress incontinence in women. N Engl J Med. 2021;384(25):2428-2436. doi:10.1056/NEJMcp1914037
- Fleischmann N et al. Urethral bulking: AUGS clinical practice statement. Female Pelvic Med Reconstr Surg. 2024;30(8):427-436. doi:10.1097/SPV.0000000000001548
- Lukacz ES et al. Urinary incontinence in women: a review. JAMA. 2017;318(16):1592-1604. doi:10.1001/jama.2017.12137
← Learn more about Urinary Incontinence