A Retrospective Multicenter Study on Outcomes After Midurethral Polypropylene Sling Revision for Voiding Dysfunction

Molden, Stephanie; Bracken, Jessica; Nguyen, Aimee; Harvie, Heidi S.; White, Amanda B.; Hammil, S. L.; Patterson, Danielle; Tarr, Megan E.; Sanses, Tatiana; Murphy, Miles; Rogers, Rebecca G.

doi:10.1097/spv.0b013e3181f5ac07

Cited by 27 publications

(33 citation statements)

References 13 publications

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“…Despite the apparent benefits of sling incision in treating postoperative complications, our results revealed a risk of recurrence of stress urinary incontinence following the procedure in as many as 61 % of the women, which is higher than previously published rates (i.e., 21 % by Molden et al) [25]. The present study is distinct, however, in that it was conducted with a relatively large number of patients who had the same procedure (only midline incision) performed at one center and definitions of “cured patients” differed.…”

Section: Discussioncontrasting

confidence: 90%

Midurethral sling incision: indications and outcomes

Viereck

Rautenberg

Kociszewski³

et al. 2012

Int Urogynecol J

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Introduction and hypothesisControversy continues over the effectiveness of sling incision, which is the most common operative approach to treating complications following suburethral sling insertion. This retrospective analysis assessed the indications for sling incision and patient outcomes regarding resolution of complications and stress urinary incontinence.MethodsA review was conducted of the medical records of women who underwent sling incision between 2003 and 2010. Data such as surgical indications, ultrasound findings and medical outcomes were extracted from 198 records, and descriptive and inferential statistical methods of analysis were used.ResultsIn the 198 patients eligible for study inclusion, the primary reasons for sling incision were overactive bladder (68 %), voiding dysfunction (61 %), and recurrent urinary tract infections (53 %). Additional complications included dyspareunia (18 %), chronic pelvic pain (17 %), and sling exposure (15 %). Sling incision led to immediate postoperative cure of voiding dysfunction in 97 % of patients. Cure rates for overactive bladder and dyspareunia were 60 % and 94 % respectively. Chronic pelvic pain was resolved in 82 % of cases and all cases of sling exposure were cured. Eighty-five (61 %) of the 140 patients who were continent before sling incision developed recurrent stress urinary incontinence (SUI) postoperatively.ConclusionsThese findings indicate that sling incision can be highly successful in improving voiding dysfunction and dyspareunia, and moderately successful in curing overactive bladder and chronic pain. However, SUI may recur in more than 60 % of the patients undergoing sling incision. Consequently, patients being considered for a sling incision procedure should be informed about this possible complication.

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Section: Discussioncontrasting

confidence: 90%

Midurethral sling incision: indications and outcomes

Viereck

Rautenberg

Kociszewski³

et al. 2012

Int Urogynecol J

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“…Early intervention runs the risk that the intervention may be completely unnecessary and that any associated complications would be regrettable. Molden et al41 retrospectively assessed outcomes after sling revision for both retropubic and transobturator slings. Techniques included urethral dilation, stretching of the sling, incision to release the sling, resection of the central portion of the sling, and urethrolysis.…”

Section: Managementmentioning

confidence: 99%

Prevention and management of postoperative urinary retention after urogynecologic surgery

Geller¹

2014

IJWH

130

116

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Postoperative urinary retention (POUR) is a frequent consequence of gynecologic surgery, especially with surgical correction of urinary incontinence and pelvic organ prolapse. Estimates of retention rates after pelvic surgery range from 2.5%–43%. While there is no standard definition for POUR, it is characterized by impaired bladder emptying, with an elevation in the volume of retained urine. The key to management of POUR is early identification. All patients undergoing pelvic surgery, especially for the correction of incontinence or prolapse, should have an assessment of voiding function prior to discharge. There are several ways to assess voiding function – the gold standard is by measuring a postvoid residual. Management of POUR is fairly straightforward. The goal is to decompress the bladder to avoid long-term damage to bladder integrity and function. The decision regarding when to discontinue catheter-assisted bladder drainage in the postoperative period can be assessed in an ongoing fashion by measurement of postvoid residual. The rate of prolonged POUR beyond 4 weeks is low, and therefore most retention can be expected to resolve spontaneously within 4–6 weeks. When POUR does not resolve spontaneously, more active management may be required. Techniques include urethral dilation, sling stretching, sling incision, partial sling resection, and urethrolysis. While some risk of POUR is inevitable, there are risk factors that are modifiable. Patients that are at higher risk – either due to the procedures being performed or their clinical risk factors – should be counseled regarding the risks and management options for POUR prior to their surgery. Although POUR is a serious condition that can have serious consequences if left untreated, it is easily diagnosed and typically self-resolves. Clinician awareness of the condition and vigilance in its diagnosis are the key factors to successful care for patients undergoing surgical repair.

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“…In addition, studies that have evaluated risk factors for needing revision surgery have kept their scope small and have not studied all possible factors. While there are published studies that report on outcomes after revision surgery for vaginal mesh complications [8][9][10][11], there are only a few studies that have focused on the indications and risk factors for needing sling revision surgery specifically [12,13]. Therefore, the primary objective of this study was to determine the indications and risk factors for needing midurethral sling revision in a large cohort of women undergoing midurethral sling placement at a tertiary care center.…”

Section: Introductionmentioning

confidence: 99%