Minimally Invasive Surgery for Stress Urinary Incontinence – Mesh Complications

Abstract

Currently, the most commonly performed surgeries for stress urinary incontinence (SUI) are mesh midurethral slings (MUS). They are minimally invasive outpatient procedures, and they are as effecttive as traditional suburethral slings, open retropubic colposuspension (Burch, Marshall-Marchetti), and laparoscopic retropubic colposuspension. They have a short operative time and fewer postoperative complications. In the paper we present results from a prospective study of 214 patients with SUI who underwent midurethral sling placement: 68 patients with retropubic slings (TVT) and 146 patients with transobturator slings (TVT-O) followed over 12 months. The operations were performed at the Department of Obstetrics and Gynaecology at the Medical Faculty, Skopje, R. Macedonia and at the Department of Obstetrics and Gynaecology, General Hospital, Sibenik, Croatia. All MUS placements (TVT and TVT-O) were performed by one surgeon (urogynaecologist) using the standard surgical technique and operative and postoperative protocol for those procedures. TVT and TVT-O meshes are polypropylene macroporous meshes produced by "Ethicon" We evaluated mesh complications related to the procedure (Table 1) and complications specific to the mesh (Table 2). In the article are presented the data from up-to-date literature related to the evaluated topic parallel to our results. We can conclude that all our findings on the evaluated groups are comparable with the data from competent literature. Instead of a conclusion we would like to suggest continuous follow-up of all minimally invasive procedures with midurethral slings placement for collecting experience of side-effects and complications and improving those procedures which are gold standard today in the treatment of SUI.Key words: mesh, complication, stress incontinence, retropubic, transobturator.Stress urinary incontinence (SUI) is a common disorder that affects a large number of women and their quality of life. SUI also has a significant socioeconomic impact. This disorder affects 6% to 35% of women and is characterised by an increase in intra-abdominal pressure that exceeds urethral closure pressure and results in involuntary leakage of urine. Symptomatic SUI of low grade (occasional or first grade of SUI -Green classification) may be treated conservatively. Candidates for surgical treatment are women with SUI grades two and three (Green), women who decline or have failed conservative treatment. Currently, the most commonly performed surgeries for SUI are mesh midurethral slings (MUS). They are minimally invasive outpatient procedures, and they are as effective as traditional suburethral slings, open retropubic colposuspension (Burch, MarshallMarchetti), and laparoscopic retropubic colposuspension. They have a short operative time and fewer postoperative complications [1,2].. In a meta-analysis of 62 trials, the average success rate was over 80% with patient satis-