Native tissue sling

A sling is made using your own body tissue (fascia) taken from the wall of your abdomen (rectus fascia) or thigh (fascia lata).

The fascia is the thin but very tough layer that covers the muscles. To get this, a small cut will be made either just below the bikini line (as shown in this illustration) or on the outside of the upper leg. It is then placed in position under the urethra through a cut in the vagina. 

Surgeons may use dissolvable or permanent sutures (stitches). Ask your surgeon which sutures they use and the benefits and risks of each. 

Source: British Association of Urogynaecologists (BSUG)

This surgical option can be done at the same time as other vaginal and abdominal surgery, for example, prolapse surgery.

• This is invasive surgery, involving a cut on the abdomen or in the outer thigh. 
• The surgery takes longer than surgery for urethral bulking agents and mesh tape/slings. 
• There is a higher risk of wound complications like infection than for urethral bulking agents and mesh tape/slings. But the risk is the about the same as for colposuspension. 
• Recovery takes longer (usually 4 to 6 weeks) than surgery for urethral bulking agents and mesh tape/slings. But recovery time is about the same as for colposuspension.
• When used, permanent stitches stay in the body. 
• The sling may need to be loosened, cut or removed.
• You may have short-term difficulty emptying your bladder and need to use a catheter to manually empty it. 
• Fascia lata surgery can cause pain and discomfort in the leg during recovery. 
• Rectus fascia surgery can cause pain the abdomen, groin and hips. This may sometimes persist.

With native tissue sling surgery, there is a higher risk of:

• short-term difficulty emptying the bladder (need for self-catheterisation)
• wound complications like infection 
• urgency and urge incontinence.

There is also the risk of:

• fluid collecting beneath the wound site (called seroma formation)
• thigh bulge (where the fascia was taken from your leg)
• pain and discomfort in the leg or abdomen during recovery (depending on where the fascia was taken from). 

Occasionally, if the mesh sling is placed too tightly and you have ongoing diffculty weeing, the sling may need to be cut or loosened. This is usually done within 6 weeks of surgery. 

This type of surgery involves being in hospital for around 1 to 3 days, including the day of surgery. 

For surgery following a fascia lata sling, 2 to 4 weeks off work is normal. 

For surgery involving a rectus fascial sling, 4 to 6 weeks off work is normal.