Complications of midurethral slings and their management

Abstract

REvIEw S120Cite as: Can Urol Assoc J 2012;6(5):S120-2. http://dx.doi.org/10.5489/cuaj.12197 AbstractWhile midurethral slings are associated with a low rate of morbidity, complications can arise intraoperatively or following the procedure. Management of midurethral sling complications is relatively straightforward and urgency is dictated by the severity of the complications, potential for long-term negative effects, and bother to the patient. M idurethral synthetic slings are currently the most common surgical treatment for women with stress urinary incontinence (SUI). While generally well tolerated and safe, these operations are not free of complications. This review will discuss the more common complications that can be associated with these interventions and provide some guidance on how to deal with them if they arise. Intraoperative complicationsPotential intraoperative complications include bleeding, urethral and bladder injury. The overall relative risk of perioperative complications for transobturator procedures has been compared to retropubic procedures in a meta-analysis.1 The overall risk of complications related to surgery for SUI is considerably lower with the transobturator approach (pooled odds ratio 0.40 in randomized trials and 0.21 in observational cohort studies; Fig. 1). Significant bleedingSignificant bleeding is a potential intraoperative complication of midurethral sling insertion, occurring in less than 1% of procedures. Additionally, evidence suggests that the likelihood is lower with the transobturator approach relative to retropubic slings. 2,3If bleeding is encountered, one should attempt to control the vessel if possible. Otherwise, the best advice is to complete the procedure as quickly as possible. There are many different approaches that can be used to manage the bleeding itself, including tamponade, hemostatic agents, vaginal packing, and embolization. Bladder and urethral injuriesUsing the retropubic approach, there is an approximate 5% risk of bladder or urethral perforation with trocar passage. The risk is considerably lower (<1%) with the transobturator approach. Expert recommendations from the American Urological Association (AUA) state that intraoperative cystoscopy should always be performed, to help minimize the risk of urinary tract injury. 1Should a bladder injury occur, the trocar should be removed and replaced. Depending on the size of the injury, one might consider draining the bladder for 24 to 48 hours with an indwelling catheter. Most bladder injuries during SUI surgery are inconsequential, with no effect on outcomes.Urethral injury usually results from dissection in the wrong plane. Urethral repair should be done using 4-0 Vicryl, and the periurethral fascia should be closed. The American Urological Association's (AUA) recommendation is that "synthetic sling surgery is contraindicated in stress incontinent patients with a concurrent urethrovaginal fistula, urethral erosion, intraoperative urethral injury and/or urethral diverticulum." 4 Other, less common potential...

Long term safety, efficacy and clinical outcomes of transobturator tension free tape (inside-out technique) in women with stress urinary incontinence

“…[13][14][15] One was seen in present study. This is probably due to increased tension on the tape, similar observation was made by Romero et al 16 One (1.62%) patient had increased (PVRU) Post void residual urine on USG which is similar to that reported by Romero et al (3%) and by Bozkurt et al (3.2%).…”

Multimodal vaginal toning for bladder symptoms and quality of life in stress urinary incontinence

“…In patients who are unresponsive to conservative measures, surgical intervention such as midurethral sling or open colposuspension may be offered. Although initial surgical outcomes are generally positive, operative complications such as bladder perforation, voiding dysfunction, and neurological symptoms are known risks [8]. Additionally, surgical efficacy diminishes over time such that a repeat procedure is necessary in 5–10% of patients after 5 years [9].…”

A Giant Female Urethral Stone: An Unusual Complication after MidUrethral Sling Operation

“…pH, ionic strength, duration and the hydrophobic characteristics of biomaterials have been accused [1][2][3] . History of kidney stones, metabolic diseases and UTI are other risk factors.…”

“…Although it has a high success rate and is well tolerated, it may cause some complications. Those complications include intraoperative complications (massive bleeding, injury to urethra and bladder), early complications (lower urinary tract symptoms, recurrent UTI, extrusion and pain) and late complications (vaginal extrusion, lower urinary tract perforation, bowel perforation, obstruction, lower urinary tract symptoms and recurrent UTI) [1] . A giant female urethral stone has never been reported in the literature as a late complication.…”