Midurethral slings in the mesh litigation era

Chang, John; Lee, Dominic

doi:10.21037/tau.2017.04.06

Cited by 17 publications

(17 citation statements)

References 46 publications

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“…Due to the widespread use of mid-urethral slings over the last two decades, as a surgical treatment option for SUI [16], the number of SUI surgeries increased dramatically by 27% [17]. However, in recent years the overall number of procedures has declined due to regulatory warnings worldwide [18,19].…”

Section: Uds Use By Luts Typementioning

confidence: 99%

The role of urodynamics in females with lower urinary tract symptoms

Mousa

Dossary

Hashim

2019

Arab Journal of Urology

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Objective: To review the role of urodynamic studies (UDS) in females with lower urinary tract symptoms (LUTS), as LUT dysfunction is a common condition. The role of UDS was and continues to be vital in the assessment of such cases; however, utilisation is still debated amongst clinicians as to when and in which conditions it should be used. Materials and methods: We conducted a literature review using the Medical Literature Analysis and Retrieval System Online (MEDLINE) search engine from year 1990 until August 2018, using the keywords: 'female urology', 'lower urinary tract symptoms', 'urodynamic', 'incontinence', 'overactive bladder', 'bladder outlet obstruction'. We also reviewed the latest international guidelines related to the subject including: the

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Section: Uds Use By Luts Typementioning

confidence: 99%

The role of urodynamics in females with lower urinary tract symptoms

Mousa

Dossary

Hashim

2019

Arab Journal of Urology

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“…13 Though the use of prosthetic materials is now restricted (in some countries suspended), the occurrence of graft-related complications has caused concern among perspective patients. [13][14][15] Therefore, women may consider alternative options.…”

Section: Introductionmentioning

confidence: 99%

Laser therapy for urinary incontinence and pelvic organ prolapse: a systematic review

Mackova

Daele

Page

et al. 2020

BJOG

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Background Laser therapy is now being proposed for the treatment of pelvic organ prolapse (POP) and urinary incontinence (UI). Objectives To systematically review the available literature on laser therapy for POP and UI. Search strategy PubMed, Web Of Science and Embase were searched for relevant articles, using a three‐concept (POP, UI, laser therapy) search engine composed as (concept 1 OR concept 2) AND concept 3. Selection criteria Only full‐text clinical studies in English. Data collection and analysis Data on patient characteristics, laser setting, treatment outcome and adverse events were independently collected by two researchers. There was a lack of methodological uniformity so meta‐analysis was not possible and the results are presented narratively. Main results Thirty‐one studies recruiting 1530 adult women met the inclusion criteria. All studies showed significant improvement either on UI, POP or both; however the heterogeneity of laser settings, application and outcome measures was huge. Only one study was a randomised controlled trial, two studies were controlled cohort studies. All three were on UI and used standardised validated tools. The risk of bias in the randomised controlled trial was low on all seven domains; the controlled studies had a serious risk of bias. No major adverse events were reported, mild pain and burning sensation were the most commonly described adverse events. Conclusions All studies on vaginal and/or urethral laser application for POP and UI report improvement, but the quality of studies needs to be improved. Tweetable abstract There is weak evidence that laser therapy is effective for urinary incontinence and pelvic organ prolapse #LASER#UI#POP.

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“…Synthetic mid‐urethral sling (MUS) is the most prevalent incontinence surgery worldwide for stress urinary incontinence (SUI). Vaginal sling exposure occurs in 1–3% of women and can cause significant morbidity and is a major focus of litigation . Small, asymptomatic exposures can be managed conservatively with watchful expectancy with or without vaginal estrogen in postmenopausal patients.…”

Section: Introductionmentioning

confidence: 99%

Mid‐urethral sling revision for mesh exposure–long‐term outcomes of two surgical techniques from a comparative clinical retrospective cohort study

Karmakar

Dwyer

Nikpoor

2020

BJOG

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Objective To compare vaginal closure with versus without sling excision in the management of vaginal sling exposure following mid‐urethral sling (MUS). Design Clinical retrospective cohort study. Setting Tertiary urogynaecological centre in Australia. Population Women with urodynamic stress urinary incontinence (SUI) who had a MUS (n = 2823) during 1999–2017 with a follow‐up period up to December 2018. Thirty‐three women (1%) had sling exposure and 31 required surgical intervention (1%). Methods Clinical review with analysis of surgical database and patient records. Main outcome measures The primary outcome was successful closure and resolution of exposure‐related symptoms without the need for re‐surgery. Secondary outcomes were repeat procedure and recurrent incontinence following revision. Results Mean follow up was 103 months. Of the 20 women with a primary excision and closure approach, 19 had successful closure. Seven of 11 women with simple vaginal closure without excision needed another surgery for recurrent mesh exposure. Recurrence of stress incontinence did not occur in any of the four who had ‘successful’ closure without excision. Of those who had sling division/removal without a concomitant stress continence procedure, 32% (7/22) required further surgery. Conclusion Sling excision and repair have better outcomes with less recurrence of sling exposure compared with simple closure. Following sling removal, one of three women will develop SUI recurrence and require surgery. Tweetable abstract #Slingexcision &repair leads to less recurrence of exposure versus #simpleclosure for #slingmeshexposure.

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Midurethral slings in the mesh litigation era

Cited by 17 publications

References 46 publications

The role of urodynamics in females with lower urinary tract symptoms

The role of urodynamics in females with lower urinary tract symptoms

Laser therapy for urinary incontinence and pelvic organ prolapse: a systematic review

Mid‐urethral sling revision for mesh exposure–long‐term outcomes of two surgical techniques from a comparative clinical retrospective cohort study

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