Midurethral sling
A midurethral sling is a narrow strip of soft mesh tape placed under the middle of the urethra through a small cut in the vagina. It supports the urethra so it stays closed when you cough, laugh, sneeze or exercise, and it is the most common and most studied surgery for stress leakage in women.
Also called MUS, TVT, tension-free vaginal tape, TOT, transobturator tape, TVT-O, retropubic sling, bladder sling
- Where
- Outpatient surgery center or hospital operating room
- Anesthesia
- General anesthesia, a spinal, or local numbing with IV sedation
- Time in the room
- About 30 to 45 minutes
- Hospital stay
- Usually same day
- Going home with
- Usually none; some women go home with a catheter for a few days
- Back to normal
- About 1 to 2 weeks for daily activities
- Back to work
- About 1 to 2 weeks for desk work; 4 to 6 weeks for heavy lifting
Overview
Stress urinary incontinence means leaking urine when pressure in your belly rises: with a cough, sneeze, laugh, jump or lift. It happens when the urethra (the short tube that carries urine out of the bladder) loses its support and cannot stay closed under pressure. Childbirth, aging, menopause and heavy lifting all play a part. It is very common, and it is treatable.
A midurethral sling is a strip of soft polypropylene mesh tape about 1 cm (less than half an inch) wide. It is placed through a small cut inside the vagina, under the middle part of the urethra. The tape is not pulled tight. It lies loosely like a hammock, and when you cough, the urethra is pressed against it and stays closed.
There are two main routes. In a retropubic sling (often called TVT), the tape arms go up behind the pubic bone and come out through two tiny cuts just above it. In a transobturator sling (TOT or TVT-O), the arms go out to the sides through openings in the pelvic bone and come out in the inner groin creases. Both work about equally well, with somewhat different side effects. A newer single-incision mini-sling uses only the vaginal cut.
You may have heard about lawsuits and warnings about vaginal mesh. In 2019 the FDA ordered companies to stop selling mesh products placed through the vagina to repair prolapse (a dropped bladder or uterus). That order did not include midurethral slings for stress leakage. These slings remain on the market, and the AUA, SUFU and AUGS continue to support them as a standard, effective treatment, with risks your surgeon should discuss openly with you.
The parts of your body involved
The bladder stores urine and empties through the urethra, a tube about 1.5 inches (4 cm) long in women. Normally the urethra rests on a firm shelf of tissue formed by the front wall of the vagina. When you cough, belly pressure squeezes the urethra against that shelf and keeps it shut. When the support weakens, the urethra drops and opens under pressure, and urine leaks. The sling rebuilds that shelf under the middle of the urethra.
- Bladder
The stretchy bag that stores urine.
- Urethra
The tube that carries urine out, about 1.5 inches long. The sling goes under its middle third.
- Vagina
Its front wall lies directly under the urethra. The small cut for the sling is made here.
- Pubic bone
The bone at the front of the pelvis. In a retropubic sling, the tape arms pass up behind it.
- Pelvic floor muscles
A hammock of muscle at the base of the pelvis. Strengthening it is the first treatment for stress leakage.
Why it’s done
A sling is offered when stress leakage bothers you enough to want surgery, and simpler steps have not been enough or you would like a lasting fix.
- Leaking with effort
Leaking when you cough, laugh, sneeze, run, jump or lift is what a sling treats best.
- Pelvic floor exercises were not enough
Many women try pelvic floor muscle training first, often with a physical therapist. If leakage still bothers you, surgery is a reasonable next step.
- A one-time treatment
Pessaries and pads work but need ongoing care. A sling is a single operation with long-lasting results for most women.
- Done having children, or close to it
Surgery is usually best after you have finished having children, since pregnancy and delivery can bring leakage back. Having children after a sling is still possible.
- Leakage that limits your life
Avoiding exercise, travel, intimacy or social plans because of leaks is a common reason women decide to go ahead.
Other options
- Pelvic floor muscle training
Daily exercises, best learned with a pelvic floor physical therapist. Helps many women, especially with mild leakage, and has no risks. Usually tried first.
- Vaginal pessary or insert
A soft silicone device worn in the vagina that supports the urethra. Some are worn only during exercise.
- Urethral bulking injections
A gel injected around the urethra through a thin scope. A quick procedure with a fast recovery, but less effective than a sling and often repeated.
- Sling made from your own tissue (fascial sling)
A strip of your own tissue, taken from the belly wall or thigh, placed under the bladder neck. Avoids mesh. Works well, with a longer recovery and more trouble emptying afterward.
- Burch colposuspension
Stitches lift the tissue beside the urethra up to a strong ligament behind the pubic bone, through a belly incision or keyholes. Avoids mesh, with a longer recovery.
- Pads and lifestyle changes
Weight loss, treating a chronic cough, avoiding constipation and emptying your bladder on a schedule help some women. Many choose to manage with pads.
Getting ready
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Weeks before
The week before
The day before and the morning of
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep
You get antibiotics through an IV. Most women have general anesthesia or a spinal. Some surgeons use local numbing with IV sedation, so you can cough during the operation to help set the tape.
After the operation
Right afterward
- Recovery room
You may feel cramping like a period, pressure in the vagina, and aching in the lower belly or groin.
- The voiding trial
Before you go home, the nurse fills your bladder through a catheter or waits for you to pee, then measures what is left with a bladder scan. This checks that the sling is not blocking your urine.
- If you cannot empty well enough
Some women go home with a catheter for a few days, or are taught to pass a thin catheter themselves. This usually resolves as swelling settles.
- Packing
If vaginal packing was used, it is removed before you leave.
- Pain medicine
Most women need only acetaminophen and an anti-inflammatory such as ibuprofen, if safe for them, with a few stronger tablets if needed.
- Going home
Most women go home the same day, a few hours after surgery.
At home
- Soreness
Mild cramping and soreness for a few days. After a transobturator sling, aching in the groin or inner thighs is common for 1 to 2 weeks.
- Spotting and discharge
Light bleeding or a pink or brown discharge for 1 to 2 weeks is normal as the stitches dissolve.
- Peeing
Your stream may be slower than before. Sit fully on the toilet, relax, and lean forward a little. Call if you feel you cannot empty.
- Nothing in the vagina
No tampons, douching or sex for about 6 weeks, so the cut can heal fully over the tape.
- Lifting and exercise
Walk from the first day. Many surgeons ask you to avoid lifting more than about 10 to 15 pounds and high-impact exercise for 4 to 6 weeks. Practice varies, so follow your own team's advice.
- Bathing
Showers are fine from the next day. Avoid baths, pools and hot tubs for about 2 weeks, or until your surgeon says the cut has healed.
- Bowels
Avoid constipation and straining. Drink plenty of fluids and use a stool softener while taking pain medicine.
- Driving
Usually within a few days, once you are off opioid pain medicine and can brake hard without pain.
- Work
Most women return to desk work in about 1 week, longer for jobs with heavy lifting.
Recovery timeline
- Day 0Surgery
The sling is placed, and most women go home the same day.
- Days 1 to 3Sore and tired
Cramping, light spotting and a slow stream are common.
- Week 1Back to light routine
Many women are back to desk work and driving.
- Weeks 2 to 4Healing
Discharge and groin aches settle. Continue to avoid heavy lifting and anything in the vagina.
- About 6 weeksCheck-up
Your surgeon checks the vaginal cut, your emptying and your leakage, and usually clears you for sex and exercise.
- 3 to 6 monthsSettled result
The tape is fully anchored, and you can judge the result.
- Long termLasting results
For most women results last 10 years or more. Tell future doctors you have a sling, and report any new pain, discharge, bleeding or pain with sex.
What it feels like
Most women are surprised by how quick the recovery is compared with what they feared. The emotional side is often bigger: years of planning around bathrooms, concern about mesh headlines, and then the odd experience of laughing without leaking.
Before surgery
Many women feel embarrassed to talk about leaking, and anxious about mesh after seeing law firm advertisements.
What helpsAsk your surgeon how many slings they do, what problems they see and how they treat them. Direct questions deserve direct answers.
Waking up
Cramping like a period, pressure in the vagina, and a feeling of needing to pee.
What helpsPain medicine on a schedule and a warm pack on the lower belly help.
The first pee
The stream can feel slow and strange, and some women have to wait for it to start. Being told you need a catheter for a few days is disappointing.
What helpsRelax, sit fully and give it time. A few days with a catheter does not mean the sling has failed.
The first week at home
Tiredness, light spotting, and after a transobturator sling, an ache in the inner thighs when you get up or walk.
What helpsShort walks, rest, and acetaminophen and ibuprofen on a schedule for the first few days.
The first sneeze
Many women brace for a sneeze or cough out of habit, then notice they stayed dry.
What helpsIt can take weeks to trust it. Keep wearing a liner at first if that helps you feel secure.
Back to exercise
Running, jumping or dancing without planning around leaks can feel freeing.
What helpsBuild back gradually after you are cleared, and keep up pelvic floor exercises.
Sex again
Some women feel nervous the first time after surgery.
What helpsWait until you are cleared and use lubricant. Tell your surgeon if you have pain or your partner feels a rough edge, since that can be a sign of mesh exposure, which is treatable.
How well it works
Success means leaking far less or not at all with effort. Most women have a good result that lasts many years.
- High success rate
In large studies, about 8 to 9 in 10 women are cured or much improved in the first year. In long-term follow-up of retropubic slings, most women are still dry or nearly dry more than 15 years later.
- Both routes work similarly
A large NIH-funded U.S. trial (TOMUS) found similar success with retropubic and transobturator slings at one year. Retropubic slings had more trouble emptying and bladder punctures; transobturator slings had more groin and thigh pain.
- Urgency may change
If you also had urgency before surgery, it may improve, stay the same, or less often get worse. A sling treats stress leakage.
- Follow-up
A visit about 6 weeks after surgery checks healing, emptying and leakage. Tell your doctor at any time about pain, bleeding, discharge or pain with sex.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
A slow stream or incomplete emptying in the first days or weeks. Some women need a catheter for a few days.
Common for 1 to 2 weeks after a transobturator sling, and usually fades.
Treated with antibiotics.
Expected for 1 to 2 weeks while the stitches dissolve.
Less common
Found and fixed during the camera check. It usually heals without lasting effects.
Some women develop a stronger urge to pee or urgency leakage. Medicines and bladder training usually help.
The edge of the tape can work through the vaginal lining, causing a rough spot, discharge, spotting, or discomfort for a partner during sex. Often treated with estrogen cream or a small trim of the exposed tape.
A small number of women need a short procedure to loosen or cut the tape. Leakage can return afterward.
Some women still leak, or leakage returns over the years. Other treatments remain possible.
Rare
Rarely, tape is found inside the bladder or urethra, at surgery or later. It needs to be removed.
Uncommon, but can be hard to treat. Partial or full removal of the tape may help, though it does not always relieve pain.
Very rare, and mostly with the retropubic route.
Rare. It may require removal of the tape.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- You cannot pee at all, or only dribble, and your bladder feels full and painful
- Heavy vaginal bleeding, such as soaking more than one pad an hour
- Pain that keeps getting worse instead of better, or new severe pain in the belly, groin or legs
- Foul-smelling vaginal discharge, or redness and pus at one of the small skin cuts
- Burning with urination along with fever or back pain
- Pain or swelling in one leg, chest pain, or trouble breathing (call 911)
Questions to ask your surgeon
- Are you sure my leakage is mainly stress leakage and not urgency?
- Do you recommend a retropubic or a transobturator sling for me, and why?
- How many slings do you place each year, and how do you handle complications?
- What are the chances I will need a catheter after surgery?
- Which product will you use, and will I get a record of it?
- How do the options without mesh compare for someone like me?
- Should I finish having children before I have this?
- When can I return to exercise, lifting and sex?
- What symptoms could mean mesh exposure, and what would you do about it?
- If the sling does not work or causes problems, can it be removed or redone?
Words you may hear
- Stress urinary incontinence
- Urine leaking with coughing, sneezing, laughing, lifting or exercise.
- Urgency incontinence
- Leaking with a sudden, strong need to urinate.
- Mixed incontinence
- Having both stress and urgency leakage.
- Urethra
- The tube that carries urine out of the bladder.
- Midurethral sling
- A narrow mesh tape placed under the middle of the urethra to support it.
- Polypropylene mesh
- A soft, woven medical plastic that tissue grows into and holds in place.
- Retropubic
- Behind the pubic bone. Describes the TVT route for the tape.
- Transobturator
- Through the openings in the pelvic bone toward the inner thighs. Describes the TOT route.
- Cystoscopy
- A look inside the bladder and urethra with a thin camera.
- Voiding trial
- A check before you go home that you can empty your bladder.
- Post-void residual
- The urine left in the bladder after you pee, measured with a quick ultrasound.
- Mesh exposure
- When part of the tape shows through the vaginal lining.
- Pessary
- A removable silicone device worn in the vagina for support.
- Pelvic organ prolapse
- Sagging of the bladder, uterus or rectum into the vagina.
Common questions
Is this the same mesh as in the lawsuits?
Many of the warnings and lawsuits focused on larger pieces of mesh placed through the vagina to repair prolapse, and in 2019 the FDA ordered those products off the market. Midurethral slings use a much smaller strip, were not part of that order, and are supported by the AUA, SUFU, AUGS and ACOG. Some lawsuits have involved slings too, and slings carry real risks, such as mesh exposure and pain, which your surgeon should explain.
Retropubic or transobturator: which is better?
They work about equally well. Some studies suggest retropubic slings hold up slightly better for more severe leakage, with a higher chance of bladder puncture and trouble emptying. Transobturator slings cause more short-term groin pain. Your surgeon will suggest one based on your situation.
Will the sling fix my urge to rush to the bathroom?
A sling treats leakage with effort. Urgency may improve, stay the same or get worse, and it is treated separately with bladder training, medicines or other therapies.
Can I get pregnant after a sling?
Yes. Pregnancy and delivery can bring leakage back, which is why many surgeons suggest waiting until you are done having children. Talk with your obstetrician about delivery plans.
How long does a sling last?
For most women, results last many years. Long-term studies of retropubic slings show most women still dry or nearly dry after more than 15 years.
Will my partner be able to feel it?
Normally no. If your partner feels something sharp, or you have pain with sex, see your surgeon. This can be a sign of mesh exposure, which can be treated.
Can the sling be removed if there is a problem?
Yes, partly or fully. Cutting or trimming the tape is a small procedure. Removing all of it is a bigger operation, does not always relieve pain, and leakage may return.
Sources this page draws on
- American Urological Association (AUA) and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), Updates to Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline (2023)
- American Urogynecologic Society (AUGS) and SUFU, Position Statement on Mesh Midurethral Slings for Stress Urinary Incontinence
- U.S. Food and Drug Administration (FDA), Urogynecologic Surgical Mesh Implants
- New England Journal of Medicine, Retropubic versus Transobturator Midurethral Slings for Stress Incontinence (TOMUS trial) (2010)
- American College of Obstetricians and Gynecologists (ACOG) and AUGS, Practice Bulletin No. 155: Urinary Incontinence in Women (2015)
- Urology Care Foundation, Stress Urinary Incontinence (SUI)
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.