Complications of Biologic and Synthetic Slings and Their Management

Evaluation and Management of Mid-Urethral Sling Complications

“…The patient may then be brought back to the operating room at another time or arterial embolization by interventional radiology may be considered. Successful outcomes using embolization have also been reported for cases of profuse bleeding with the transobturator approach where direct visualization can be limited [22,23].…”

“…The true incidence of mesh perforations is unknown, but it is estimated to be 0.7-5 % for retropubic slings and 0-0.5 % for transobturator slings [31,59]. It is unclear whether a mesh perforation results from progressive erosion of the mesh over time or from a missed perforation at the time of the procedure [22]. Of note, the TOMUS trial did not identify any urethral or bladder perforations for transobturator slings [21].…”

“…Of note, the TOMUS trial did not identify any urethral or bladder perforations for transobturator slings [21]. Various etiologies leading to mesh exposure include sling tension, extensive vaginal dissection resulting in devascularization of the urethra, missed trocar injury at the time of MUS placement, traumatic catheterization or dilation, or compromised urethral vascularity such as from estrogen deficiency [22]. Patients with a mesh perforation can present with variable symptomatology.…”

“…Most mild, venous bleeding can be controlled with passive tamponade by closing the vaginal epithelium expeditiously and inserting vaginal packing. However, obturator, iliac, and femoral vessel injuries have been reported [22]. In the retropubic approach, if the trocars are inserted too lateral, the pelvic vessels can be injured.…”

“…Non-surgical therapies may be offered for minimal obstruction such as self-intermittent catheterization (SIC), indwelling catheterization, urethral dilation, medical management, or biofeedback [22]. However, these therapies are limited and surgical intervention is often necessary including: sling loosening, sling incision, sling excision, or urethrolysis (infrapubic, retropubic, or transvaginal) [54].…”