Impact on urinary incontinence after management of complications related to a retropubic midurethral sling

Abstract

Introduction and hypothesis The most common complications to midurethral sling (MUS) operations for stress urinary incontinence are postoperative urinary retention (POUR), vaginal MUS exposure, and urgency. They are well described but consensus regarding their management is missing. An evaluation of the treatment of POUR, exposure and urgency after the MUS procedure in our department was implemented. Incontinence status after treatment of complications was evaluated. Methods A review of the medical records of women undergoing MUS procedures from 1 January 2017 to 31 December 2021 (n = 329). Results A total of 279 women (85%) had no complications. Fifty women had one or more complications. Twenty-three women (7%) experienced POUR. Final treatment in 9 women was clean intermittent self-catheterization (CISC). All remained continent. Nine women had the MUS mobilized. This was successful in 8 women who remained continent. Six women had their MUS incised (one after unsuccessful mobilization). Four became incontinent again and 2 remained continent. Eight women had vaginal MUS exposure. Seven attempted recovering of the MUS. This was successful in 3 patients. The remaining had a partial MUS removal. Only 33% remained continent after removal. Ten patients developed de novo urge, but only 2 needed medication. Conclusions Mobilization of the MUS must be considered the optimal treatment for POUR when CISC fails. It is the most effective intervention with the best effect on POUR and the lowest risk of incontinence. Concerning vaginal exposure, a trial of recovering should be attempted as the risk of incontinence when undergoing a partial removal of the MUS is considerable.

Sonography as a Diagnostic Tool in Midurethral Sling Complications: A Narrative Review

“…In a retrospective analysis, 1.9% of women undergoing the TVT procedure were diagnosed with post-surgical hematomas [63], a frequency mirrored in another study [84]. Stanford et al found that 2% of MUS patients developed hematomas [12], while Juhl et al observed a 1% hematoma rate post-TVT EXACT implantation [11]. Similarly, Petri et al reported a 2% incidence of retropubic hematomas post-MUS [76].…”

“…A systematic review and meta-analysis reported de novo urgency occurrence between 3.1% and 29% [72]. In the aforementioned Danish study, ten of the enrolled women, accounting for 3%, developed de novo urgency [11]. Anger et al noted a 15.2% incidence of urge incontinence among 1356 sling procedures in women over 65 [33].…”

“…Anger et al, analyzing sling surgeries in over 65-year-old females, observed a 6.9% incidence of outlet obstruction among 1356 procedures within a year [33]. A Danish study evaluating 329 TVT surgeries over five years noted urinary retention as the most common complication, affecting 7% of the women [11]. A broader review highlighted that urinary retention related to the tape occurs in about 14.4% of patients, particularly with the retropubic approach [12].…”

“…Based on a thorough overview, exposure rates vary significantly, with TVT slings ranging from 0% to 1.5% and TOT slings up to 10.9% [58]. A Danish study found a 2.4% exposure rate in 329 TVT cases over five years [11], while a comparison between TVT and SPARC procedures showed erosion rates of 4.8% and 10.5%, respectively [64]. In the analysis performed by Tunitsky-Bitton et al, exposure was notable in five subjects (8%), and the rate of exposure did not differ between the compared sling types (TVT, TOT, and TVT-O) [41].…”

“…A recently published study in Denmark involving 329 women over five years found that while 85% reported no complications post-MUS, 15% experienced one or more complications [11]. This emphasizes the importance of careful patient selection, detailed preoperative counseling, meticulous surgical execution, and vigilant postoperative care to minimize complications and optimize patient outcomes [12].…”