Mesh vs non-mesh options for stress incontinence
If you’re thinking about surgery for stress incontinence, you probably have questions about mesh. The most common procedure, the midurethral sling, uses a narrow strip of mesh. Several non-mesh options work well too.
Both mesh and non-mesh surgery are good, well-studied choices. None is “first” or “second best.” The right one depends on your anatomy, your health, your past surgeries, and how you feel about mesh. This page lays out the facts so you and I can decide together.
How the mesh sling works
The midurethral sling places a thin strip of polypropylene mesh under the middle of your urethra. The urethra is the tube you pee through. The strip acts like a hammock. When you cough, laugh, or lift, it supports the urethra so you don’t leak.
Surgeons place it through a small cut inside the vagina, often using an approach called TVT or TOT. It has been the standard stress incontinence surgery since the late 1990s.
A few facts:
- More than 3.6 million have been placed worldwide.
- About 8 in 10 women are dry a year later, and the results last for years.
- It takes around 30 minutes, and you usually go home the same day.
- The tape is narrow, roughly 1 cm wide. That is very different from the large mesh sheets once used for prolapse.
The non-mesh options
You have more than one way to fix stress incontinence without mesh. The main choices are below.
Sling from your own tissue (autologous fascial sling). I take a strip of strong tissue (fascia) from your lower belly wall and use it as the sling under your urethra. No synthetic material goes in. Getting that strip means a cut on your belly, usually about 6 to 8 cm long. The harvest and the repair of the belly wall can be painful, so recovery takes longer than it does with the mesh sling.
Burch procedure (colposuspension). I lift and support the area next to your urethra with a few stitches anchored to a nearby ligament. No mesh and no tissue harvest. This pairs well with prolapse surgery done through the belly.
Urethral bulking. I inject a soft gel into the wall of your urethra to help it stay closed. There’s no sling and no cut. I can often do it in the office with local numbing. It’s less likely to fully stop leaking than a sling, and you may need a repeat injection later. But it’s a low-risk option, and it’s a strong choice if you’re older, on blood thinners, or have had pelvic radiation.
Why the news about mesh is different
You may remember alarming news stories about mesh. Almost all of that was about a different product: large sheets of mesh placed through the vagina to repair prolapse. The FDA pulled those prolapse mesh kits off the U.S. market in 2019.
The sling for incontinence is not the same device:
- It’s a narrow tape, not a large sheet.
- It sits in one specific, well-studied spot under the urethra.
- It has safety data going out to 17 years.
- Every major urogynecology society still recommends it, and the FDA never recalled it.
One sad side effect of the prolapse-mesh news is that some women now avoid getting help for leaking. I don’t want that to be you. Let’s look at the real numbers.
Side-by-side comparison
| Factor | Mesh sling | Sling from your own tissue |
|---|---|---|
| Material | Polypropylene mesh | Your own tissue |
| Dry or much improved | About 80% at 1 year | About 65–80% |
| Repeat surgery for leaking | Around 2% over 5 years | Around 2% over 5 years (lowest of the surgeries) |
| Procedure time | About 30 minutes | About 60–90 minutes |
| Recovery | 2–4 weeks | 4–6 weeks (the harvest site needs to heal) |
| Extra incision | No | Yes, a 6–8 cm cut on your belly that can be painful to heal |
| Trouble emptying the bladder | Less common | More common (about 14% need short-term help) |
| Mesh in your body | Yes, a narrow tape | None |
The numbers for the two slings are close. The trade-off is real but simple: the mesh sling is quicker with an easier recovery, while the tissue sling avoids synthetic material but takes longer to do and to heal.
My take
I get why mesh worries people. The news was scary, and your concern is fair. The key thing is that the sling for leaking and the prolapse mesh that made headlines are two different products used in different ways. The incontinence sling has a track record I trust, and I place it often.
If you’d rather avoid any synthetic material, the sling made from your own tissue is a genuinely good option. It works about as well and lasts. The trade-off is real, though: it takes longer in the operating room, and the belly incision where I take the tissue can be painful and adds to your recovery.
Which option tends to fit which person
A mesh sling often fits if you:
- want the quickest procedure and fastest recovery
- feel comfortable with the safety data
- have straightforward stress leaking
A non-mesh option often fits if you:
- feel strongly about avoiding synthetic material
- had a problem with mesh before
- need a fix after a previous sling
- have a urethra or vaginal tissue that raises the odds of mesh wearing through
- are older, on blood thinners, or have had pelvic radiation (bulking is often the safest choice here)
None of these rules out the other path. They’re starting points for our conversation.
Where physical therapy fits
Surgery isn’t the only tool. Pelvic floor physical therapy helps many women with stress leaking, and it carries no surgical risk. We have pelvic floor physical therapists in our office, plus a regional network across northeast Wisconsin and the Upper Peninsula of Michigan.
PT and surgery aren’t either/or. Some women try therapy first, some do it alongside other treatment, and some go straight to surgery. We’ll pick based on what you want.
Making the decision together
The best treatment is the one that fits your symptoms, your health, and what matters to you. I’ll walk you through each option, answer your questions, and we’ll choose together. Most insurance plans cover these procedures; my office can help you check your coverage.
Related reading
References
- American Urogynecologic Society and SUFU. Joint Position Statement on Midurethral Slings for Stress Urinary Incontinence. Female Pelvic Med Reconstr Surg. 2021. doi:10.1097/SPV.0000000000001096
- Kobashi KC, et al. Surgical Treatment of Female Stress Urinary Incontinence: AUA/SUFU Guideline. J Urol. 2017. doi:10.1016/j.juro.2017.06.061
- Richter HE, et al. Retropubic versus Transobturator Midurethral Slings for Stress Incontinence. N Engl J Med. 2010. doi:10.1056/NEJMoa0912658
- Albo ME, et al. Burch Colposuspension versus Fascial Sling to Reduce Urinary Stress Incontinence. N Engl J Med. 2007. doi:10.1056/NEJMoa070218
- Fleischmann N, et al. Urethral Bulking. Urogynecology. 2024. doi:10.1097/SPV.0000000000001548
- Wu JM. Stress Incontinence in Women. N Engl J Med. 2021. doi:10.1056/NEJMcp1914037
- ACOG/AUGS. Urinary Incontinence in Women (Practice Bulletin No. 155). Obstet Gynecol. 2015. doi:10.1097/AOG.0000000000001148