Predictors of sling revision after mid‐urethral sling procedures: a case–control study

Clancy, Aisling A.; Gauthier, Isabelle; Ramirez, F. Daniel; Hickling, Duane; Pascali, Dante

doi:10.1111/1471-0528.15470

Cited by 8 publications

(3 citation statements)

References 31 publications

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“…We identified higher rates of past or current smoking among patients undergoing sling removal, however, there were no differences when patients were stratified by complication type. These findings corroborate previous studies, which identified smoking as an independent predictor of mesh exposure and urogynaecological mesh revision or removal 31–33 …”

Section: Discussionsupporting

confidence: 92%

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Symptomatic improvement after mesh removal: a prospective longitudinal study of women with urogynaecological mesh complications

Pace

Baranski

Palcsey

et al. 2021

BJOG

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Objective To compare clinical characteristics and outcomes in patients undergoing excision of polypropylene urogynaecological mesh for pain, mesh exposure or both.Design Prospective, longitudinal cohort.Setting Academic tertiary referral centre.Population Women undergoing complete vaginal mesh excision for mesh exposure and/or pain.Methods Clinical and patient-reported outcomes assessing pain (visual analog scale, VAS), bother (Pelvic Floor Distress Inventory, PFDI) and functional impact (Pelvic Functional Impact Questionnaire, PFIQ) were collected at baseline, 6, 12 and 24 months after complete mesh excision. Outcomes were compared by mesh type (sling, prolapse [transvaginal or sacrocolpopexy mesh], both) and complication (pain, exposure, both).Main outcome measures 'Much better' or 'Very much better' on Patient Global Impression of Improvement (PGI-I) up to 2 years after removal.Results Of 173 women, 48 underwent removal for pain, 27 for exposure and 98 for exposure plus pain. 'Moderate to severe' baseline symptoms were reported by 75%; the most prevalent and severe symptom was dyspareunia. Patients with pain alone were most bothered (PFDI median 234.2, interquartile range 83, P = 0.02) and had the highest functional impact (PFIQ median 181, interquartile range 138, P < 0.001). After excision, only 33.3% of women with pain alone reported 'improved' symptoms (PGI-I), versus 73.9% with exposure, 58.3% with exposure plus pain (P = 0.03) with no differences in PGI-I by mesh type. VAS scores decreased in all groups, but PFDI and PFIQ did not improve in pain patients.Conclusions In women experiencing a pain complication after urogynaecological mesh insertion, mesh removal often does not improve symptoms.

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Section: Discussionsupporting

confidence: 92%

“…These findings corroborate previous studies, which identified smoking as an independent predictor of mesh exposure and urogynaecological mesh revision or removal. [31][32][33]…”

Section: Discussionmentioning

confidence: 99%

Symptomatic improvement after mesh removal: a prospective longitudinal study of women with urogynaecological mesh complications

Pace

Baranski

Palcsey

et al. 2021

BJOG

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“…Severe cases are recommended for surgical intervention to provide support to the pelvic floor using mid-urethral slings with synthetic sub-urethral tape or mesh ( Oliphant et al, 2009 ; Dwyer and Karmakar, 2019 ), which remains the most common surgical procedure for patients with SUI with success rate of 72–77% at 24 months ( Imamura et al, 2019 ). Unfortunately, 12% of those implanted with SUI slings suffer from at least one serious adverse event such as pain, mesh exposure, dyspareunia, voiding dysfunction, urge incontinence, vaginal wall erosion, or recurrent urinary tract infections ( Gomes et al, 2017 ; Gurol-Urganci et al, 2018 ; FDA, 2019 ; Keslar et al, 2020 ), and approximately 4% of patients have to adjust or remove the implant 60 months after initial surgery ( Clancy et al, 2019 ; Brennand et al, 2020 ). Understanding the anatomy and physiology of individual components will pave the way for the development of personalized diagnosis and more effective treatment options in pelvic floor disorders.…”

Section: Introductionmentioning

confidence: 99%

Secondary urethral sphincter function of the rabbit pelvic and perineal muscles

Hernández-Reynoso

Rahman²,

Hedden³

et al. 2023

Front. Neurosci.

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Perineal and pelvic floor muscles play an important role in continence by providing mechanical support to pelvic organs. It is also known that the pubococcygeus muscle (PcM) contracts in the storage phase and is inactive during voiding, while the bulbospongiosus muscle (BsM) is active during the voiding phase. Recent evidence suggested an additional role of these muscles in supporting urethral closure in rabbits. However, the individual role of perineal and pelvic muscles as urethral sphincters is not well-defined. Here we evaluated the individual, sequential and synergistic roles of the PcM and BsM in assisting urethral closure and defined the optimal electrical stimulation parameters that can effectively contract these muscles and increase the urethral pressure (Pura) in young nulliparous animals (n = 11). Unilateral stimulation of either the BsM or PcM at 40 Hz induced modest increases in average Pura (0.23 ± 0.10 and 0.07 ± 0.04 mmHg, respectively). Investigation on the changes in Pura evoked by stimulation frequencies between 5 and 60 Hz show that sequential contralateral PcM-BsM activation at 40 Hz induced a 2-fold average Pura increase (0.23 ± 0.07 mmHg) compared to that evoked by PcM stimulation. Simultaneous activation of PcM and BsM at 40 Hz also showed an increased average Pura (0.26 ± 0.04 mmHg), with a 2-fold increase in average Pura observed during the unilateral sequential PcM-BsM stimulation at 40 Hz (0.69 ± 0.2 mmHg). Finally, stimulation at 40 Hz of the bulbospongiosus nerve (BsN) induced an approximate 4-fold increase in average Pura (0.87 ± 0.44 mmHg; p < 0.04) compared to that elicited by BsM stimulation, confirming that direct nerve stimulation is more effective. Together, this study shows that in the female rabbit, both perineal and pelvic muscles support of the urethral function during continence, and that unilateral stimulation of the BsN at 40–60 Hz is sufficient to achieve maximal secondary sphincter activity. The results also support the potential clinical value of neuromodulation of pelvic and perineal nerves as bioelectronic therapy for stress urinary incontinence.

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A comprehensive look at risk factors for mid-urethral sling revision surgery

et al. 2020

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Predictors of sling revision after mid‐urethral sling procedures: a case–control study

Abstract: Risk factors for sling revision include smoking, previous hysterectomy, and concomitant prolapse surgery.

Cited by 8 publications

References 31 publications

Symptomatic improvement after mesh removal: a prospective longitudinal study of women with urogynaecological mesh complications

Symptomatic improvement after mesh removal: a prospective longitudinal study of women with urogynaecological mesh complications

Secondary urethral sphincter function of the rabbit pelvic and perineal muscles

A comprehensive look at risk factors for mid-urethral sling revision surgery

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