Dyspareunia associated with paraurethral banding in the transobturator sling

Cholhan, Hilary J.; Hutchings, Timothy B.; Rooney, Kristin E.

doi:10.1016/j.ajog.2010.01.061

Cited by 46 publications

(29 citation statements)

References 21 publications

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“…Improvement of sexual life due to cure of coital incontinence after surgery has been reported [25]. One of the rare but known complications after sling plastic, in particular the transobturator sling, is dyspareunia [26]. In this study, women were seldom provided with information regarding influence of surgery on sexual function.…”

Section: Discussionmentioning

confidence: 92%

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Are women adequately informed before gynaecological surgery?

2017

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Background: Surgery for pelvic organ prolapse, urinary incontinence, and hysterectomy are the most common gynaecological surgeries that can affect the function of the bladder and bowel as well as one's sexual life. There is evidence that adequate patient information given preoperatively regarding expected outcomes of surgery is important because well-informed patients are more satisfied with the results of surgery and recover faster. However, there is little known about the amount and quality of information given to women before surgery. This study investigates whether women received information before gynaecological surgery on the effect of surgery with respect to the functioning of the bladder (micturition, ability to stay continent) and the bowel (empty bowel) as well as the surgery's effect on sexual functioning. Methods: A prospective, cross-sectional study was conducted. Women undergoing hysterectomy, surgery for vaginal prolapse, or surgery for urinary incontinence (n = 972) and included in the Swedish National Register for Gynaecological Surgery participated in the study. A questionnaire was developed and distributed to the women along with the preoperative questionnaire from the register. Results: About 50% of the women undergoing prolapse surgery were supplied with information regarding the effect of the surgery with respect to remaining continent, to emptying bowels, micturitaion, and sexual life. One out of four women undergoing hysterectomy received information about the effect of the surgery on the sexual life and bladder function. In the incontinence group, the given information about the surgery's effect on bladder function and sexual function was 80 and 30%, respectively. Conclusion: Surgery in the vagina and the genital organs may affect function of the organs close to the surgical area (i.e., bladder and bowel) and may affect sexual function. According to this study, women are inadequately informed before surgery. Access to information via oral and written counselling needs to be improved.

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Section: Discussionmentioning

confidence: 92%

“…In our study, women in the incontinence group were provided with information regarding the effects of surgery on their UI to a high degree. The effect of midurethral sling surgery on sexuality is debated [25,26]. Improvement of sexual life due to cure of coital incontinence after surgery has been reported [25].…”

Section: Discussionmentioning

confidence: 99%

Are women adequately informed before gynaecological surgery?

2017

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“…Although < 1% of women returned to theatre because of a complication, it is notable that several of the papers reporting mesh exposures did not comment on the level of re-intervention required for these patients (Table 4). Recently, the risk of para-urethral banding and dyspareunia post-MUS has come under focus, with higher rates reported after TOT than after TVT procedures [20]. Although, intuitively, banding would seem less likely with a short single-incision sling, this has not previously been reported.…”

Section: Discussionmentioning

confidence: 99%

TVT‐Secur mini‐sling for stress urinary incontinence: a review of outcomes at 12 months

Walsh¹

2011

BJU International

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What’s known on the subject? and What does the study add?Although synthetic mid‐urethral slings are now generally accepted as the first‐line surgical treatment of female stress incontinence, there is concern that newer slings are being used prematurely, before sufficient evidence exists. The 3rd generation “mini‐slings” are inserted via a single incision which, theoretically, reduces iatrogenic morbidity. It is vital, however, that efficacy is not compromised. To date, a number of papers have examined short‐term outcome data following the TVT‐Secur, with wide variations in reported cure rates at up to one year.This is the largest review of outcomes following TVT‐Secur published to date (n= 1178 cases from 10 studies). Cure rate, both objectively and subjectively, was 76%, which is similar to more established mid‐urethral slings. Intra‐operative vaginal perforation rates and rates of mesh exposure in the first 12 months post‐operatively were both 2%. The incidence of de novo OAB was 10%. No serious complications were recorded amongst this large cohort. Although the TVT‐Secur appears to be a safe procedure, its long‐term efficacy moving forward requires close scrutiny.• Synthetic mid‐urethral slings (MUSs) are considered the first choice surgical procedure for stress urinary incontinence. Recent publications have raised concerns about the efficacy of third generation single‐incision mini‐slings. The present paper is a systematic review of studies reporting 12‐month outcomes after the TVT‐Secur (TVT‐S) procedure.• Pubmed/Medline online databases, abstracts from recent International Continence Society and International Urogynecological Association annual scientific meetings and the Clinicaltrials.gov and Controlled‐trials.com online trial registries were searched for English‐language articles containing the terms ‘TVT‐Secur’, ‘TVT Secur’ or ‘mini‐sling’. The primary outcomes were objective and subjective cure rates at 12 months. Secondary outcomes included peri‐operative (vaginal perforation, urinary retention, urinary tract infection [UTI]) and postoperative (mesh exposure, de novo overactive bladder (OAB), dyspareunia and return to theatre) complication rates.• Among 1178 women undergoing the TVT‐S procedure, from 10 studies, both objective and subjective cure rate at 12 months was 76%, with objective cure significantly higher in women undergoing the ‘U‐type’ approach. Vaginal perforation was a complication in 1.5% of cases, with a 2.4% incidence of mesh exposure in the first year. The incidence of de novo OAB symptoms was 10%. Rates of urinary retention (2.3%), UTI (4.4%), dyspareunia (1%) and return to theatre for complications (0.8%) were low. In the first year after a TVT‐S procedure 5% of women required repeat continence surgery.• Longer‐term studies and randomized comparisons with more established MUSs are required before TVT‐S should be routinely used in the surgical treatment of stress urinary incontinence.

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“…Ross et al found that 52 of 85 women had a palpable sling on exam one year after TOT midurethral sling compared with only 15 out of 90 in the TVT group; however, only 11 and 9 subjects experienced tenderness with palpation, respectively [ 24 ]. De novo dyspareunia secondary to anterior vaginal wall banding in the paraurethral folds immediately adjacent to the midurethral sling was reported in 16 % of patients undergoing TOT but was absent in patients undergoing a retropubic midurethral sling approach [ 73 ].…”

Section: Sexual Dysfunctionmentioning

confidence: 99%

Female Stress Urinary Incontinence Surgery Complications: Diagnosis, Evaluation, and Management

Gilchrist

2014

Minimally Invasive Therapy for Urinary Incontinence and Pelvic Organ Prolapse

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Stress urinary incontinence (SUI) affects upwards of 40 % of American women [ 1 ]. Over the past several years, surgical treatment of SUI has evolved from mainly transvaginal needle suspensions, anterior vaginal wall plications, and retropubic suspensions to various types of slings, most commonly midurethral polypropylene slings. Sling surgeries for SUI can be classifi ed by composition (autologous fascia, biologic or synthetic nonabsorbable materials), location of the sling (midurethral or beneath the bladder neck), and approach of placement (retropubic or transobturator). A full discussion of all the types of slings and sling complications is beyond the scope of this article but specifi c operations will be discussed where appropriate. The majority of the following discussion concerns midurethral slings via transobturator or retropubic approaches. Surgical treatment of SUI comprises some of the most commonly performed operations in the United States. Thus, it is important to understand how to avoid and, when necessary, diagnose and treat complications related to these surgeries. Prevention of ComplicationsAlthough most complications are treatable and reversible, the optimal scenario is to prevent or minimize potential for adverse outcomes. This process begins in the preoperative period, initiated during the diagnostic evaluation and work-up. When determining the optimal surgical therapy for patients with urinary incontinence, many factors should be considered, including etiology and type of urinary incontinence and/or prolapse, bladder capacity, renal function, sexual function, medical comorbidities, or concurrent abdominal or pelvic pathology requiring surgical correction, prior abdominal and pelvic surgery, and fi nally, a patient's suitability for and willingness to accept the risks of surgery.Standard preoperative evaluation of an individual with stress incontinence should include a focused history and physical, objective demonstration of SUI, an assessment of post-void residual urine volume and urinalysis and culture if warranted [ 2 ]. It is recommended that the incontinence be characterized and symptom impact and patient expectations be assessed. Additional studies may be indicated to evaluate the lower urinary tract, including pad tests and voiding diary, cystoscopy, and imaging. Furthermore, voiding function should be characterized, with noninvasive fl ow and post-void residual measurements, with invasive urodynamics reserved for patients with abnormal fi ndings, mixed incontinence or

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Dyspareunia associated with paraurethral banding in the transobturator sling

Cited by 46 publications

References 21 publications

Are women adequately informed before gynaecological surgery?

Are women adequately informed before gynaecological surgery?

TVT‐Secur mini‐sling for stress urinary incontinence: a review of outcomes at 12 months

Female Stress Urinary Incontinence Surgery Complications: Diagnosis, Evaluation, and Management

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