Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed March 2026
Mesh vs Non-Mesh Options for Urinary Incontinence
If you’re considering surgery for stress urinary incontinence, you may have questions about mesh. The midurethral sling — the most commonly performed incontinence procedure — uses a narrow synthetic mesh tape. Non-mesh alternatives also exist, including autologous fascial slings (using your own tissue). Understanding the differences helps you make an informed choice.
Understanding Mesh Midurethral Slings
The midurethral sling (also called TVT or TOT) places a narrow strip of lightweight polypropylene mesh under the urethra for support. It’s been the gold standard for stress incontinence surgery since the late 1990s.
Key facts:
- Millions performed worldwide with extensive safety data
- 85-95% success rate
- 30-minute outpatient procedure
- Narrow tape (about 1cm wide) — very different from large mesh sheets used for prolapse
Understanding Non-Mesh Alternatives
Autologous fascial sling: Uses a strip of your own tissue (typically from the abdominal wall or thigh) to create a sling under the urethra.
Urethral bulking agents: Injectable materials placed around the urethra (no sling at all).
An Important Distinction
Media coverage of “mesh complications” primarily involved transvaginal mesh for prolapse — large sheets of mesh placed through the vagina. The midurethral sling for incontinence is fundamentally different:
- Narrow tape vs. large sheet
- Placed in a specific, well-studied location
- Decades of positive safety data
- Endorsed by every major urogynecology society worldwide
Side-by-Side Comparison
| Factor | Mesh Midurethral Sling | Autologous Fascial Sling |
|---|---|---|
| Material | Synthetic polypropylene mesh | Your own tissue (fascia) |
| Success rate | 85-95% | 80-90% |
| Procedure time | 30 minutes | 60-90 minutes |
| Recovery | 2-4 weeks | 4-6 weeks (donor site healing) |
| Additional incision | No | Yes (abdomen or thigh for tissue harvest) |
| Long-term durability | Excellent | Excellent |
| Mesh concerns | Rare exposure (1-2%) | No mesh |
Dr. Stewart’s Perspective
I understand why patients have concerns about mesh — the media coverage was alarming. But it’s crucial to distinguish between the mesh sling for incontinence and the transvaginal mesh for prolapse. They’re different products used in different ways. The midurethral sling has an outstanding safety record that I’m very comfortable with.
For patients who strongly prefer to avoid any synthetic material, the autologous fascial sling is an excellent alternative. The success rates are similar, though the procedure is longer and recovery involves healing the tissue harvest site.
Who Is the Best Candidate for Each?
Mesh midurethral sling may be ideal if you:
- Want the shortest, simplest procedure
- Are comfortable with the mesh safety data
- Want faster recovery
- Have straightforward stress incontinence
Non-mesh options may be ideal if you:
- Have strong personal preference to avoid synthetic material
- Have had previous mesh complications
- Need a revision of a prior sling
- Have urethral or vaginal conditions that may increase mesh exposure risk
Making Your Decision
The best treatment is the one that aligns with your symptoms, values, and life. Dr. Stewart will walk you through both options in detail during your consultation, answer all your questions, and help you feel confident in whatever path you choose.