Midurethral sling incision: indications and outcomes

Abstract

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.

Transvaginal six-arm mesh OPUR in women with apical pelvic organ prolapse — analysis of short-term results, pelvic floor ultrasound evaluation

“…It was suggested that tape-urethra distance < 3 mm is a risk factor for urge de novo and for post-void residual [13,14,20,21]. In most of our patients mesh-urethra distance was > 3 mm.…”

“…In 4 cases value was between 40% and 47%. This position should allow implanting suburethral tape without risk of collision in all analyzed women -optimal relative tape position for TVT and TOT should be between 50% and 70% [13,14,20,21].…”

“…Because of the risk of collision between tape and mesh (collision phenomenon) it is important that mesh should not be located near the mid urethra [20,21]. In all of the analyzed patients mesh was located far enough from mid-urethra so there should not be the risk of collision between sling and mesh in them.…”

Evaluation of per-operative cough stress test during transobturator mid-urethral sling surgery

“…If these treatments fail, tape incision is the best way to solve voiding problem. However, SUI recurs in almost 60% of patients (31). In our study, among patients which had TOT performed without CST, two patients (2.1%) had transient voiding difficulties and two patient were treated with repeated catheterization for 1 week.…”

Nutukusių moterų šlapimo nelaikymo gydymas atliekant TVT operaciją Vilniaus universiteto ligoninės Santariškių klinikų urologijos centre

“…Tačiau nutukimas nėra rizikos veiksnys tokių pacienčių šlapimo nelaikymo chirurginiam gydymui, kuris šiais laikais yra minimaliai invazyvus. TVT operacija turėtų būti taikoma nutukusioms pacientėms dėl šio būdo paprastumo, saugumo, tinkamumo, gerų pooperacinių rezultatų ir mažo komplikacijų dažnio, palyginti su normalios kūno masės ligoniais [31]. VUL SK Urologijos centre TVT yra pasirinkimo operacija su gerais rezultatais nutukusioms ar antsvorio turinčiomis pacientėms, nes turime didelę šių operacijų patirtį.…”