Prof. Dr. Emel Akoğlu
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- 57+years exp.
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Kidney & Bladder
Sling surgery for urinary incontinence
When sling surgery for urinary incontinence is considered after pelvic floor training and other treatment, how it compares with bulking injections, colposuspension, medication and an artificial sphincter, what success rates and long-term studies show, approximate costs in Turkey against the UK, US and Germany, recovery, risks and how to prepare questions for a surgeon.
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Prof. Dr. Zerrin Biçik Bahçebaşı
UrologyVerified
- 37+years exp.
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Sling surgery for urinary incontinence in Turkey: is it the right next step?
Sling surgery for urinary incontinence is an operation for people who leak urine when they cough, sneeze, laugh, lift or run, known as stress urinary incontinence. A narrow supporting strip is positioned under the urethra so that it stays closed when pressure in the abdomen rises. It is normally not the first treatment. Guidelines such as those from the UK National Institute for Health and Care Excellence (NICE) advise a trial of supervised pelvic floor muscle training for at least three months, weight loss where relevant and bladder habit changes before surgery is discussed. Surgery becomes a reasonable choice when leakage still limits daily life, work or exercise despite those steps.
This guide is written for that decision point. It explains how to tell whether you are a candidate, how sling surgery compares with the alternatives, what the results show, what it costs in Turkey against the UK, US and Germany, how recovery works and what risks to weigh. For the technical differences between tape types, see our separate page on the urology treatments in Turkey hub. It is general information and not a substitute for an examination.
What should be tried before sling surgery for urinary incontinence?
A sensible order of treatment runs from least to most invasive.
- Pelvic floor muscle training with a physiotherapist, usually for three months or more. Many women improve noticeably, and some avoid surgery.
- Lifestyle changes: weight loss, treating a chronic cough or constipation, cutting caffeine and fluid timing for urgency.
- Medication if urgency is part of the picture; drugs do not cure stress leakage but help overactive bladder (see medication therapy for urinary incontinence).
- Devices and injections such as vaginal pessaries or urethral bulking agents.
- Surgery: a sling, a colposuspension or, rarely, an artificial sphincter.
If you have already completed the first steps with limited benefit, surgery is a natural next consideration. A surgeon who suggests an operation without asking what you have tried is skipping an important part of the assessment.
Sling, bulking injections, colposuspension or sphincter: how do they compare?
| Option | Best suited to | Typical limits |
|---|---|---|
| Mid-urethral sling | Stress incontinence not helped by exercises; the most studied operation | Mesh-related risks; not for urgency-dominant leakage |
| Fascial sling | Women who prefer their own tissue, or after failed surgery | Bigger operation, longer recovery |
| Bulking injections | Older or frail patients, those wanting a minimal procedure | Effect fades; repeat injections are often needed |
| Colposuspension (Burch) | Women who decline mesh or are having abdominal surgery anyway | Open or keyhole abdominal operation; more recovery time |
| Artificial urinary sphincter | Severe leakage, mostly men after prostate surgery | Mechanical device; needs training and possible later revision |
The decision rests on your diagnosis, anatomy, previous surgery, age and preferences. The artificial urinary sphincter implantation page explains the device, which is generally reserved for severe cases. Ask the surgeon to explain why they favour one option and whether there is a non-mesh route.
Which tests show whether sling surgery will help?
Before surgery most clinics will take a history, examine you for prolapse and pelvic floor strength, test a urine sample, ask you to keep a bladder diary for three days, and measure how well the bladder empties. Urodynamic studies measure pressures while the bladder fills and while you cough or strain; they help show whether the leakage is truly stress type and whether the bladder is overactive. Some guidelines allow surgery on a clear history and examination without urodynamics when the picture is straightforward, but they are advised when symptoms are mixed, when earlier surgery failed or when there is prolapse. A cystoscopy may be added when there is blood in the urine or a suspected bladder problem.
Does sling surgery for urinary incontinence work?
For stress incontinence, mid-urethral slings are among the best-supported operations in pelvic surgery. Reviews and long-term follow-up studies show that most women are dry or much better, with many studies reporting success in around 80 to 90 per cent at one to five years. The chance of success is lower with urgency-dominant leakage, a weak urethral sphincter, repeat surgery, obesity and smoking. A few women continue to leak, develop new urgency or have trouble emptying the bladder. National registries and the NHS provide patient leaflets that give realistic expectations, and a good surgeon will quote ranges rather than promise a cure.
How much does sling surgery for urinary incontinence cost in Turkey compared with the UK, US and Germany?
These are approximate ranges for the operation in a private hospital, not quotes from any hospital.
| Country | Approximate cost range |
|---|---|
| Turkey | €2,500 – €5,500 |
| United Kingdom | €4,500 – €9,000 |
| United States | €8,000 – €20,000 |
| Germany | €4,000 – €9,000 |
The price depends on the type of sling (a fascial sling or a revision costs more), whether urodynamic tests and a cystoscopy are included, whether another procedure such as a prolapse repair is combined, the type of anaesthesia and the nights in hospital. Check whether the quote lists the tape or technique, the tests and a post-operative review, and whether a catheter or extra nights could add to the cost.
What happens on the day of surgery?
You usually arrive fasting, meet the surgeon and anaesthetist and have spinal or general anaesthesia; sometimes local anaesthesia with sedation is used. The operation takes about 20 to 40 minutes for a tape, longer for a fascial sling because the strip of tissue must first be harvested. A catheter is placed, small incisions are made under the urethra and in the groin or above the pubic bone, the tape is positioned without tension and a cystoscopy checks the bladder. You wake in the recovery room, drink and walk, and the nurses check that you can empty your bladder. Many people go home the same day or after one or two nights, though a clinic abroad will usually keep you in Turkey for a short review.
Who should wait or consider something else?
Surgery is usually delayed if you are planning pregnancy (pregnancy and childbirth can undo the effect), have an untreated bladder infection, have incomplete bladder emptying, have mainly urgency symptoms, or are in the first months after childbirth when pelvic floor strength is still recovering. Smoking and obesity reduce success and raise the risk of wound problems. If you have a large prolapse, the surgeon may combine procedures or advise a different operation. Tell the team about previous pelvic surgery, radiotherapy, blood thinners and any history of problems with mesh.
How long is recovery after sling surgery?
The first week brings mild pain, spotting and a feeling of tightness in the groin. Walking is encouraged from day one. Most women return to desk work after about one week, avoid heavy lifting, running and sexual intercourse for four to six weeks and do not use tampons or swim during that time. Plan for three to five nights in Turkey so the bladder-emptying check and first review are done before travel. The full benefit is judged at about three months once swelling has settled, and pelvic floor exercises should continue for life. Constipation and heavy straining should be avoided. If you cannot pass urine, have a fever or have heavy bleeding, contact the clinic at once.
What are the risks, and how serious are the mesh concerns?
Possible problems include injury to the bladder or urethra during the operation, trouble emptying the bladder, new urgency, urinary infection, bleeding, groin pain and pain during sex. Mesh can erode through the vaginal wall or into the urethra or bladder, sometimes months or years later, and removal can be difficult. These complications are uncommon, but the controversy led the UK to pause the use of mesh for stress incontinence in 2018 and reintroduce it under stricter oversight; patients are encouraged to receive a full discussion of alternatives. Questions about the exact tape brand, the surgeon's experience and a registry record matter more than any slogan. The NHS, NICE and national urology and gynaecology societies publish patient information on all of these points.
How do I choose a surgeon and hospital, and what should I ask?
Look for a urologist or urogynaecologist with regular experience of continence surgery, a licensed hospital with an anaesthetist and a clear written plan. Red flags include a price without any assessment, no mention of alternatives or mesh risk, pressure to pay a deposit quickly, no named surgeon and promises of a guaranteed cure. Read how our process works and request a plan through our free quote page.
Questions to ask the clinic:
- Is my leakage stress, urgency or mixed, and which tests confirm it?
- Which sling or other operation do you recommend, and what are the alternatives?
- Which tape brand will be used, and is a non-mesh option appropriate for me?
- How many continence operations does the surgeon perform each year?
- How many nights are included, and who handles problems once I am home?
Conditions treated with Sling Surgery for Urinary Incontinence
Hospitals with Urology in Turkey
Frequently asked questions
It is an operation that places a narrow strip of mesh or your own tissue under the urethra to support it. The aim is to stop urine leaking when you cough, sneeze, laugh or exercise.
Usually after at least three months of supervised pelvic floor training and lifestyle changes have not controlled stress leakage. A urologist should first confirm that the leakage is the stress type rather than urgency.
Many studies report that around 80 to 90 per cent of women with stress incontinence are cured or much improved. Results are lower with urgency-dominant leakage or earlier failed surgery, and no surgeon can promise a cure.
Approximate ranges are €2,500 to €5,500 in Turkey, against roughly €4,500 to €9,000 in the UK. The sling type, tests and nights in hospital change the price; the hospital confirms it in writing.
Most women return to desk work after about a week and avoid lifting and sex for four to six weeks. The full effect on leakage is judged at around three months.
Expect soreness in the vagina and groin for a few days, usually controlled with simple painkillers. Pain that is severe or does not settle should be reported to the surgeon.
A sling is a short operation through small cuts. Colposuspension lifts the tissue beside the urethra through an abdominal incision using stitches, avoids mesh and has a longer recovery.
Most women do well, but mesh can rarely erode or cause long-term pain. UK mesh use was paused in 2018 and resumed under tighter oversight. Ask about alternatives such as a fascial sling before agreeing.
Yes, in some women, especially after pregnancy, weight gain or with age. Pelvic floor exercises, a stable weight and avoiding constipation help protect the result.
Plan about three to five nights so that bladder emptying and early healing are checked. Fly home only when the surgeon agrees and arrange follow-up with a local doctor.
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