Incontinence Surgery: Stopping Leakage With a Minimally Invasive Sling
Stress urinary incontinence — involuntary urine leakage with physical exertion — is the most common form of urinary incontinence in women. The leakage occurs when coughing, sneezing, laughing, jumping, or exercising causes a sudden increase in abdominal pressure that overcomes the urethral closure mechanism. The result is embarrassing, limiting, and commonly undertreated because women accept it as inevitable.
The midurethral sling is the gold standard surgical treatment for stress urinary incontinence. A narrow strip of polypropylene mesh is placed under the mid-portion of the urethra through two small incisions — providing a hammock of support that restores the urethral closure mechanism when abdominal pressure increases. The procedure takes approximately 20–30 minutes, is performed under general or spinal anesthesia as an outpatient procedure, and most patients go home the same day.
Dr. Andrei performs midurethral sling procedures primarily at Lapeer County Surgery Center as a same-day outpatient procedure. The sling can also be placed at the time of prolapse repair surgery at a hospital affiliation when both conditions are being addressed simultaneously.
Stress Incontinence Surgery — Candidacy
Midurethral sling surgery is appropriate for women with stress urinary incontinence whose symptoms are significant and who have not achieved adequate relief with conservative management.
Leakage with coughing, sneezing, laughing, or exercise
The defining symptom of stress incontinence — involuntary leakage triggered by sudden increases in abdominal pressure. This is the primary indication for midurethral sling placement.
Failed pelvic floor physical therapy
Women who have completed a course of pelvic floor physical therapy without adequate improvement in leakage episodes — and for whom surgical correction is the appropriate next step.
Leakage limiting physical activity or exercise
Stress incontinence that is causing women to avoid exercise, sports, or physical activity they would otherwise participate in — a quality-of-life indication for surgical correction.
Leakage requiring protective pads daily
Women who rely on pads, liners, or protective undergarments every day because of unpredictable leakage — and for whom this is unacceptable as a long-term management strategy.
Concurrent prolapse repair with stress incontinence
Women undergoing prolapse repair surgery who also have stress urinary incontinence may benefit from concurrent sling placement at the same operative session.
Completed or not planning future pregnancy
The sling is most appropriate for women who have completed childbearing. Future pregnancy can affect sling function. Women who plan future pregnancy are counseled on the timing of surgical intervention.
How Midurethral Sling Surgery Works
Midurethral sling placement is one of the most studied procedures in urogynecology — with decades of safety and efficacy data supporting its use as the gold standard for surgical stress incontinence treatment.
The tension-free vaginal tape approach — the sling is passed through the retropubic space from the vagina to two small suprapubic incisions, providing support under the midurethra.
- 30-minute outpatient procedure
- One small vaginal incision and two small suprapubic incisions
- No permanent external sutures
- Same-day discharge for most patients
- 80–90% success rate for complete resolution of stress leakage
An alternative sling approach passing through the obturator foramen rather than the retropubic space — used when retropubic anatomy or prior surgery makes the TVT approach less favorable.
- Same-day outpatient procedure at LCSC
- Slightly different anatomical trajectory than TVT
- Comparable efficacy for most stress incontinence presentations
- Dr. Andrei selects the approach based on anatomy and prior surgical history
- Hospital setting when combined with prolapse repair
“Stress incontinence surgery has one of the highest patient satisfaction rates of any gynecologic procedure I perform. Women who have been limiting their lives because of leakage — avoiding exercise, wearing pads every day, planning social events around bathroom access — are often transformed by a 30-minute outpatient procedure.”
Before and After the Sling Procedure
Midurethral sling at Lapeer Women’s Health is a straightforward outpatient process.
Consultation and Urodynamic Evaluation
Dr. Andrei reviews your incontinence history, confirms the diagnosis of stress urinary incontinence, and may order urodynamic testing to characterize the type and severity of leakage before recommending the sling.
Pre-Procedure Preparation
Lab work and clearance are coordinated. Pre-procedure instructions include dietary restrictions before anesthesia and medication management.
Procedure Day at LCSC
You arrive at Lapeer County Surgery Center and receive general or spinal anesthesia. Dr. Andrei performs the sling procedure in approximately 20–30 minutes. You go home the same day after a brief recovery period.
Recovery and Activity Restriction
Pelvic rest — no intercourse, heavy lifting, or strenuous exercise — is required for four to six weeks to allow the sling to incorporate into the surrounding tissue. Dr. Andrei reviews your recovery at two weeks and clears you at six weeks.
What Midurethral Sling Surgery Achieves
Midurethral sling surgery has one of the highest success rates of any gynecologic procedure.
Approximately 80–90% of women achieve complete resolution of stress urinary incontinence after midurethral sling placement — dry at one year with no additional treatment.
The majority of women who do not achieve complete dryness experience a significant reduction in leakage frequency and severity — allowing return to exercise and activities previously avoided.
Long-term follow-up data at 5–10 years supports durable continence outcomes for most women after midurethral sling placement.
Questions About Incontinence Surgery
Stress Incontinence Is Not Something
You Have to Live With.
If bladder leakage is limiting your activity, affecting your confidence, or requiring daily pad use, schedule a consultation with Dr. Andrei. A 30-minute outpatient procedure may resolve it.
The information on this page is intended for educational purposes only and does not constitute medical advice. Individual symptoms, diagnoses, and treatment options vary significantly. Reading this content does not establish a physician-patient relationship with Dr. Ramona D. Andrei or Lapeer Women’s Health. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately. Please consult a qualified healthcare provider for advice specific to your situation. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
Gynecologic care for women of every age
Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.