Bladder sling surgery and urethral bulking in Salt Lake City
Leaking urine when you cough, laugh, lift, or exercise is called stress urinary incontinence, and it's one of the most treatable bladder problems. When pelvic floor therapy hasn't been enough, two procedures can help: bladder sling surgery and urethral bulking with Bulkamid. Elisabeth Ferlic, MD, is a board-certified urologist in Salt Lake City with fellowship training in voiding dysfunction and female pelvic medicine. The sections below explain how each one works, who it suits, and what the risks are.
Ask about stress incontinence treatment: call 435-344-4760 or reach out online.
Elisabeth Ferlic, MD
Board-certified urologist · Fellowship-trained in voiding dysfunction and female pelvic medicine
In this guide
- Who these procedures are for
- How slings and urethral bulking work
- Why see Dr. Ferlic for stress incontinence procedures
- What are my options?
- Sling or Bulkamid: a side-by-side comparison
- How to prepare
- What happens during the procedure
- Recovery and results
- Alternatives to slings and bulking
- Risks and side effects
- What happens at the first visit?
- Bladder sling and Bulkamid FAQs
Who these procedures are for
Both procedures treat stress incontinence that still bothers you after pelvic floor therapy or a pessary. Most women with stress incontinence never need surgery.
A sling tends to suit women who want a lasting result from one operation. Bulkamid tends to suit women who prefer to avoid surgery or mesh, who want to discuss a less invasive approach, or who still leak after an earlier operation.
If urgency is the problem
- Your leaking is mostly urgencyNeither procedure treats the sudden urge of overactive bladder, which needs its own treatment.
Before you decide
- You plan to become pregnantDiscuss pregnancy plans before choosing a procedure. Pregnancy can change continence, and the timing and treatment need individual advice.
- You have not had an evaluationTreatment depends on the type of leaking, which the urinary incontinence page explains.
How slings and urethral bulking work
Stress incontinence happens when the support around the urethra, the tube that carries urine out of the bladder, has weakened. Both procedures help the urethra stay closed under the pressure of a cough or a jump. They do it in different ways.
Mid-urethral sling
A mid-urethral sling is a narrow strip of synthetic mesh placed under the middle of the urethra, where it supports the urethra during movement or exertion. This is the operation most people mean by "bladder sling surgery," and it's the most common surgery for stress incontinence in women.
The sling goes in through a small incision inside the vagina, and your own tissue grows around it and holds it in place. A sling can also be made from a strip of your own tissue, which avoids mesh but means a larger operation and a longer recovery.
Urethral bulking with Bulkamid
Bulkamid is a soft gel made almost entirely of water. Using a small scope, the doctor places three or four deposits of gel into the wall of the urethra. The added volume helps the urethra seal, and it still opens normally when you urinate. There are no incisions.
Slings for men
Men who leak after prostate surgery can also be treated with a sling: a soft mesh tape placed under the urethra through a small incision behind the scrotum. Male slings are generally used for mild to moderate leaking, and heavier leaking is more often treated with an artificial urinary sphincter. Bulkamid is approved for adult women with stress incontinence due to intrinsic sphincter deficiency, including stress-predominant mixed incontinence. The men's urology page covers leaking after prostate surgery.
Why see Dr. Ferlic for stress incontinence procedures
Dr. Ferlic is a board-certified urologist and fellowship-trained in voiding dysfunction and female pelvic medicine. That fellowship included female pelvic reconstruction, and it covers the leaking that follows prostate surgery in men.
Her practice includes evaluation of stress incontinence and discussion of conservative care, slings, and Bulkamid. Confirm the available procedure, setting, and referral arrangements before scheduling. You hear what each one involves in a visit that isn't rushed. Read more on the About Dr. Ferlic and women's pelvic health pages.
What are my options?
A starting point for the conversation, not a prescription. Your evaluation decides what fits.
You want a lasting result from one operation
Stress leaking that remains after pelvic floor therapy
Mid-urethral sling
A mesh strip under the urethra, placed through a small vaginal incision
You'd prefer to avoid surgery or mesh
Or you still leak after an earlier operation
Urethral bulking with Bulkamid
Gel placed in the wall of the urethra with a small scope, no incisions
You want a sling without mesh
And you accept a larger operation
A sling made from your own tissue
Avoids mesh, with a larger operation and a longer recovery
Leaking after prostate surgery
Mild to moderate leaking in men
Male sling
Mesh tape under the urethra through a small incision behind the scrotum
Sling or Bulkamid: a side-by-side comparison
Neither procedure is the better one for everybody.
| Mid-urethral sling | Bulkamid | |
|---|---|---|
| Typical setting, subject to the treatment plan | Outpatient surgery; anesthesia varies | An office or procedure setting; anesthesia varies |
| Time | Usually under 30 minutes | About 10 to 15 minutes |
| Recovery | Home the same day; 2 to 6 weeks before full activity | Normal activity within about 24 hours |
| What to expect | Improves leaking for most women, and the effect tends to last | Improves leaking for many women; the effect can fade, and repeat injections are common |
| Main trade-off | Surgical and mesh-related risks | Less improvement on average than a sling |
| Possible fit | Women considering a surgical option after discussing risks and future pregnancy | Women considering an injection instead of mesh surgery |
Mid-urethral sling
- Typical setting, subject to the treatment plan
- Outpatient surgery; anesthesia varies
- Time
- Usually under 30 minutes
- Recovery
- Home the same day; 2 to 6 weeks before full activity
- What to expect
- Improves leaking for most women, and the effect tends to last
- Main trade-off
- Surgical and mesh-related risks
- Possible fit
- Women considering a surgical option after discussing risks and future pregnancy
Bulkamid
- Typical setting, subject to the treatment plan
- An office or procedure setting; anesthesia varies
- Time
- About 10 to 15 minutes
- Recovery
- Normal activity within about 24 hours
- What to expect
- Improves leaking for many women; the effect can fade, and repeat injections are common
- Main trade-off
- Less improvement on average than a sling
- Possible fit
- Women considering an injection instead of mesh surgery
How to prepare
Preparation starts with confirming the diagnosis: your history, a pelvic exam, a urine test, and a check of how well your bladder empties. Some patients also need cystoscopy before a procedure is chosen.
Before either procedure, ask for instructions about medicines, eating, drinking, and transport. Don't pause a prescribed blood thinner or other medicine without directions from the responsible clinician. Stopping smoking ahead of surgery lowers the risk of complications.
Bulkamid needs less preparation. You have a urine test, because an infection must be treated before the gel is injected, and you might get a dose of antibiotic.
Recovery and results
After a sling, many women are back to light activity within one to two weeks. Heavy lifting, strenuous exercise, and sex wait until you're cleared, commonly about 6 weeks. Surgery improves stress incontinence for most women. It doesn't treat urgency, and some leaking can remain or return over the years.
After Bulkamid, activity instructions depend on the procedure and your recovery. Confirm any restrictions before leaving. In the US clinical study behind Bulkamid's FDA approval, about three quarters of women reported being dry or improved a year after treatment, and most of them had more than one injection to get there. Some patients have repeat injections; the timing depends on the treatment plan.
Questions about which option fits you? Call 435-344-4760 or reach out online.
Alternatives to slings and bulking
Conservative treatment comes first, and it's often enough:
- Pelvic floor therapy: guided physical therapy for women, and for men after prostate surgery
- Lifestyle changes: weight loss, less caffeine, and stopping smoking
- A pessary or vaginal insert: a small removable device that supports the urethra
A separate surgical alternative is Burch colposuspension, which supports tissue near the bladder neck with stitches. Ask whether it fits your situation.
If urgency is part of your leaking, bladder Botox and nerve stimulation treat that side of the problem. If you also have a bulge or pressure, pelvic organ prolapse repair and a sling are sometimes planned together.
Risks and side effects
Both procedures carry risks; the type and likelihood differ. Possible risks of bladder sling surgery include:
What treatment can address
- Leaking when you cough, laugh, lift, or exercise
- Stress leaking that remains after pelvic floor therapy or a pessary
- Leaking after an earlier operation, with Bulkamid
- Mild to moderate leaking after prostate surgery, with a male sling
What to weigh first
- Neither procedure treats urgency
- A sling is a permanent mesh implant
- Bulkamid's effect can fade, and repeat injections are common
- Pregnancy plans affect the timing and the choice
- Temporary trouble emptying can need a catheter
- Temporary difficulty emptying the bladder, sometimes needing a catheter
- New or worse urgency and frequency
- Urinary tract infection, wound infection, or bleeding
- Injury to the bladder or nearby organs, sometimes requiring further treatment
- Groin pain, pain during sex, or mesh wearing through the vaginal tissue
- Rarely, a sling that must be loosened or removed
Bulkamid side effects are usually short-lived: pain at the injection site, burning with urination, a small amount of blood in the urine, or a urinary tract infection. In the FDA study, about 6 in 100 women needed a catheter after the procedure, usually for less than a day.
What to know about sling mesh
A mid-urethral sling is a permanent mesh implant. The American College of Obstetricians and Gynecologists (ACOG) puts the risk of the mesh wearing through the vaginal tissue at less than 5 percent. When that happens, it can cause long-lasting pain, infections, and pain during sex, and more surgery might be needed. The FDA notes that a mesh sling, like any surgery for stress incontinence, can make later repairs more difficult.
Sling mesh is a different product from the mesh formerly placed through the vagina to repair pelvic organ prolapse. In 2019 the FDA ordered manufacturers to stop selling mesh for that repair. Mesh slings for stress incontinence remain available, and the FDA continues to monitor them. ACOG states that the mesh sling is supported by the two main US specialty societies for female pelvic medicine (AUGS and SUFU).
The FDA advises surgeons to tell you whether mesh will be used, which product it is, and what your choices are without it. If you prefer to avoid mesh, the options include a sling made from your own tissue, Bulkamid, and non-surgical care.
If you cannot urinate after either procedure, seek emergency care. Contact the treating team promptly for fever, heavy bleeding, severe pain, or unusual vaginal discharge.
What happens at the first visit?
The visit starts with what has changed and what you want help with. Any treatment and follow-up plan is specific to you.
Talk through your symptoms
Bring your concerns, medication list, and relevant medical history.
Decide what needs checking
Testing depends on your symptoms and history, and some concerns need a separate workup.
Discuss a plan and follow-up
Review benefits, risks, alternatives, and what to watch for.
Before you schedule
Ask which appointments are available and whether your concern suits a video visit or needs an in-person evaluation.
Here’s what our great patients say
How long does it take to recover from bladder sling surgery?
Most women go home the same day and feel sore for a few days to a few weeks. Light activity is often possible within one to two weeks. Heavy lifting, strenuous exercise, and sex wait until your surgeon clears you, commonly about 6 weeks after surgery.
Is a bladder sling the same as the mesh that was taken off the market?
No. In 2019 the FDA ordered manufacturers to stop selling mesh used to repair pelvic organ prolapse through the vagina. Mesh slings for stress incontinence are a different product, they remain available, and the FDA continues to monitor them. A sling is still a permanent mesh implant with its own risks, so the decision deserves a full conversation with your surgeon.
How long does Bulkamid last?
The gel is a permanent material that the body doesn't absorb. The improvement in leaking can still fade over time, and many women have a second injection to reach or keep the result they want. Having Bulkamid doesn't prevent you from having a sling later.
Can men have bladder sling surgery?
Yes. A male sling treats mild to moderate leaking after prostate surgery by supporting the urethra from below. Heavier leaking is more often treated with an artificial urinary sphincter. Bulkamid is approved for adult women with stress incontinence due to intrinsic sphincter deficiency, including stress-predominant mixed incontinence.
Does insurance cover a bladder sling or Bulkamid?
Health plans commonly cover both procedures when stress incontinence has been diagnosed and conservative treatment has been tried. Coverage, prior authorization, and out-of-pocket costs vary by plan, so check with your insurer before scheduling.
Can I schedule a sling or Bulkamid procedure today?
Contact the practice to ask which visit types are available and when in-person appointments and procedures can be scheduled.
Talk with a urologist about stress incontinence
If stress incontinence still affects your life after conservative care, ask what a procedure can offer and which risks matter for you. Call 435-344-4760 or contact the practice to discuss an evaluation and availability.
This page is for general education and is not medical advice.