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Bladder Slings: Understand the Types

Patients who suffer from stress urinary incontinence (SUI) experience urine leakage when they laugh, sneeze, cough, exercise, or perform other regular activities. The condition is often caused by a weakening of the pelvic muscles after pregnancy. Bladder slings are the most common treatment for SUI. The slings are constructed of a plastic-like mesh material that’s hung around the urethra and bladder to help keep them closed.

Although there are several types of bladder slings, the most commonly used are tension-free vaginal tape (TVT) slings, transobturator tape (TOT) slings, and mini-slings. While these slings can help manage an overactive bladder, they’ve also been linked to serious health complications. Below, you’ll find information on each of the types of bladder slings and the health risks involved.

Tension-Free Vaginal Tape Slings (TVT)

The tension-free vaginal tape sling is a mid-urethral sling that’s made from synthetic polypropylene mesh. The traditional TVT slings require a retropubic surgical procedure. The retropubic area is located between the pubic bone and bladder. Incisions are made below the urethra and above the pubic bone, so that the surgeon can pass a needle with the sling attached to it through the retropubic area. Since the surgeon will lose sight of the needle when it passes through the body, this procedure carries a high risk of urethral and bladder injury. After the surgery is complete, scar tissue will form around the mesh area to hold the sling in place.

Research has shown that bladder slings are generally safe to treat SUI. However, serious health risks like mesh erosion and organ perforation can occur. The plastic-like material of the sling can erode in the body and cause mesh fragments to become embedded in the nearby tissue. In addition, the sharp edges of the mesh fragments can puncture organs near the implant, causing internal bleeding and infection.

Transobturator Tape Slings (TOT)

The transobturator tape sling is another type of mid-urethral bladder sling. Compared to TVT slings, the surgical procedure for TOT slings has a lower risk of urethral and bladder injury. The same vaginal incisions are made in order to pass the needle through the body, but rather than going through the retropubic area, the sling enters the body by the labia. After the needle is passed through the labia, it’s threaded below the urethra. This method reduces the risk of bladder injuries because the needle bypasses the retropubic area. Just like with TVT slings, the scar tissue from the surgery holds the TOT bladder slings in place without additional stiches.

While there may be fewer surgical risks with TOT slings, mesh erosion, organ perforation, and difficulty urinating after surgery can still occur with these types of slings. For example, the Mentor ObTape, which is manufactured by Johnson & Johnson, has been pulled from the market due to the higher-than-normal rates of mesh erosion. In addition, injured patients have filed lawsuits against the manufacturer under product liability law. The lawsuits allege that the Mentor ObTape caused serious injuries like painful bloody discharge, infections, and punctured organs. If you’ve experienced any of these symptoms, you should talk to your doctor immediately.


Mini-slings are the newest type of bladder slings. Mini-slings are made of the same plastic-like mesh material as the TVT and TOT slings. However, the surgical procedure is less invasive than that of TVT slings, since it doesn’t require passing a needle through the retropubic area. Unlike the TVT and TOT slings, only one vaginal incision is required for the mini-sling. The mesh is then placed in a U-shaped formation in the mid-urethra and is held in place by scar tissue.

Mini-slings have only been used since 2006, so the long-term side effects are still being studied. However, recent research has shown that even though mini-slings result in fewer bladder injuries during surgery, they may not treat incontinence problems as well as other types of bladder slings.