Two problems share one search term
If you leak urine when you cough, laugh or lift, the problem is stress urinary incontinence, and the operations support the urethra. If you feel a bulge or pressure in the vagina, the bladder has dropped into the front vaginal wall: a cystocele, or bladder prolapse, repaired with a prolapse operation. Many women have both.
American patients ask for 'bladder lift surgery', 'female bladder lift surgery' or 'bladder sling surgery' for either problem, so the name tells you little. Which problem you have decides which operations are relevant.
Types of bladder surgery for incontinence, and which use mesh
ACOG groups surgery for stress incontinence into injections, urethral slings and colposuspension. The mid-urethral sling, often called TVT (retropubic) or TOT (transobturator), is a narrow strap of synthetic mesh placed under the urethra. It is the most common of these operations, usually an outpatient procedure, and the American Urogynecologic Society and SUFU support its use.
Mesh for prolapse is separate. On April 16, 2019, the FDA ordered makers of mesh intended for transvaginal prolapse repair to stop selling it. The three products named were prolapse devices, and the FDA lists mesh slings for incontinence and mesh placed through the abdomen as separate procedures, each with its own risks and benefits. Abdominal sacrocolpopexy, which uses mesh to support the upper vagina, is still performed, and NICE lists it as an option for vault prolapse.
How risky is bladder sling surgery?
Every operation for stress incontinence carries some risk. ACOG lists injury to nearby organs, blood vessels or nerves, bleeding, infection, difficulty urinating, and continued or new leaking, and says surgery improves symptoms in most women. For a mesh sling it puts the chance of the mesh eroding through vaginal tissue at under 5 percent; erosion can cause pain or infection and may need further surgery.
NICE advises surgeons to tell women that a retropubic mesh sling is a permanent implant and that complete removal might not be possible. It also says that for every operation it recommends, with mesh or without, there is evidence of benefit but limited evidence on long-term adverse effects. So compare risks operation by operation, not mesh against no mesh.
Is it possible to have bladder sling surgery without mesh?
Yes. An autologous fascial sling, also called a pubovaginal sling, is a strip of your own tissue from the lower abdomen or thigh, passed under the urethra and stitched in place. NICE tells surgeons to offer colposuspension or an autologous rectus fascial sling, with a retropubic mesh sling as a further choice. ACOG notes this type of sling is often used after complications from a synthetic sling, or in women who react to synthetic mesh.
The trade is a bigger operation. Taking the tissue adds a second wound, ACOG describes a hospital stay of a few days, and the AUA and SUFU guideline lists wound infection, seroma, hernia and pain at the harvest site as specific risks. Burch colposuspension instead places stitches either side of the urethra to support the bladder neck. Urethral bulking injects a material, not a mesh; NICE says the effect wears off, repeat injections may be needed, and limited evidence suggests it is less effective than the operations above.
Can you fix a prolapsed bladder without mesh?
Yes. Native-tissue repair is the US clinical term for bladder prolapse surgery without mesh. For a cystocele the usual form is anterior colporrhaphy, which stitches the front vaginal wall to hold the bladder in place. NICE advises offering anterior repair without mesh to women with anterior vaginal wall prolapse, and says transvaginal mesh repair should only be used in research. What can be used instead of mesh for prolapse? Your own tissue. Its limit is recurrence, so ask the surgeon what rate they see.
Ligament-based repair is a second kind of native-tissue approach. Rather than only reinforcing the wall, it aims at the cause of descent, the stretched supports, by re-anchoring the ligaments that hold the bladder. Both are native tissue repair for bladder prolapse, and both count as bladder lift surgery without mesh.
What is done at Podo
At Gangnam Podo Women's Clinic, pelvic ligament suspension is a ligament-based native-tissue approach. Pelvic ligament suspension surgery was developed by Dr. Mo Hyung-jin, the clinic's medical director. The technique restores pelvic support by re-anchoring the patient's own lax pelvic ligaments. It is used for stress urinary incontinence, cystocele, rectocele and uterine prolapse. Pelvic ligament suspension uses the patient's own ligaments and sutures, without synthetic mesh. Pelvic ligament suspension for incontinence alone is performed under IV sedation, with same-day discharge.
The clinic performs both operations for stress urinary incontinence: pelvic ligament suspension, which uses the patient's own ligaments without synthetic mesh, and the mid-urethral synthetic mesh sling. Which one suits you is decided after examination and measurement. Vaginal laxity is measured numerically rather than judged by hand. Non-surgical options for incontinence include radiofrequency and fractional laser vaginal treatments, chosen after measurement. Urethral bulking injections are offered at the clinic; Burch colposuspension is not performed. For the autologous fascial sling, ask at consultation.
Mid-urethral slings have far more published long-term data than pelvic ligament suspension, a technique developed at one clinic. That is a real difference, and it belongs in your decision. The incontinence surgery cost page explains how a quote is built and what it includes.
Questions to ask any surgeon about mesh
Ask which operation is proposed and whether it uses synthetic mesh, your own tissue or an injected material. If mesh is involved, ask what type, whether it is permanent, and whether it can be removed and by whom; NICE asks surgeons to give written details of any implant. The AUA and SUFU guideline asks clinicians to discuss the risks of mesh and the alternatives before a synthetic sling is chosen. Ask how often the surgeon performs the operation, what recurrence rate they see, and how long they follow patients.
Travelling for treatment: what to prepare
Measurement should come before the choice of operation. Bring records of any earlier pelvic surgery, with implant details. Consultations are available in English. Medical records and receipts are issued in English on request.
Plan for 5 to 10 days in Seoul after incontinence or prolapse surgery. A final check is done 5 to 10 days after surgery, before you fly home. Avoid lifting more than 10 kg (about 22 pounds) for 8 weeks after surgery.
Results and recovery vary from person to person. This page is general information and is not a diagnosis; a consultation is needed to decide whether a procedure suits you.
Questions
What is a bladder lift surgery called?
Bladder lift is a lay term. For a bulge, the operation is usually anterior colporrhaphy, also called anterior repair or cystocele repair. For leaking, the closest match is a bladder neck suspension such as Burch colposuspension.
What is the newest treatment for bladder prolapse?
There is no single newest treatment. Newer native-tissue and ligament-based techniques exist, including pelvic ligament suspension. Newer operations have fewer years of published follow-up than slings and standard repairs, so ask which outcomes a surgeon records and for how long.
Is non-mesh bladder surgery as effective as a mesh sling?
The evidence is not equal across operations. A Cochrane review of traditional slings, which include rectus fascia slings, found some evidence of less leakage than with colposuspension in the medium term, but rated most outcomes low or very low quality.
Is mesh still used for bladder prolapse surgery in the US?
The makers withdrew mesh for transvaginal prolapse repair after the FDA's April 2019 order. Mesh placed through the abdomen, called sacrocolpopexy, is still performed.
I already have a mesh sling. Can Podo treat me?
Patients who have a sling or mesh from another clinic can be treated; if the existing mesh is well positioned, it is left in place and pelvic ligament suspension is performed. A sling or mesh that is poorly positioned can be removed at the clinic.
Sources
- US FDA: Urogynecologic Surgical Mesh Implants
- US FDA: FDA's Activities, Urogynecologic Surgical Mesh (April 16, 2019 order)
- NICE guideline NG123: Urinary incontinence and pelvic organ prolapse in women, recommendations
- American Urological Association / SUFU: Surgical Treatment of Female Stress Urinary Incontinence guideline (2023 amendment)
- ACOG patient FAQ: Surgery for Stress Urinary Incontinence
- Cochrane review: Traditional suburethral sling operations for urinary incontinence in women