Prevalence and Predictors of Bladder Outlet Obstruction in Women With Chronic Urinary Symptoms and a History of Urethral Sling Surgery

Abstract

Purpose: The objective of this study is to review patients with chronic urinary symptoms and remote urethral sling surgery to determine the prevalence and predictors of obstruction. Materials and Methods: A single-center retrospective review was performed on patients referred with chronic lower urinary tract symptoms (>6 months) and a history of urethral sling surgery. Obstruction was identified by urodynamics using the Blaivas criteria or fluoroscopy. Clinical findings for patients with and without obstruction were compared. Logistic regression was applied to identify predictors of urodynamic obstruction. The need for sling revision and post-revision outcomes were evaluated. Results: In total 105 patients were included, median age 61 years (IQR 19), median time since sling surgery 5.0 years (IQR 8). Sixty percent (63/105) met the definition for obstruction. Patients with obstruction had higher mean detrusor pressure at maximum urinary flow rate (35 vs 19 cm H 2 O) and lower maximum urinary flow rate (6.0 vs 14 mL/s; P < .05). A tight suburethral band and increased post-void residuals were significantly associated with urodynamic obstruction (P < .05). Fiftynine (59/105; 56%) patients underwent suburethral sling excision. The incidence of improvement in storage and voiding symptoms at 6 months was 43% and 87%, respectively. At 30 months post-excision, the probability of being incontinence-free was 56% (95% CI 41, 69) and the probability of being free from redo sling surgery was 75% (95% CI 55, 87). Conclusions: Obstruction is common in patients with chronic urinary symptoms and history of urethral sling surgery. Patients undergoing sling revision should be observed for persistent storage symptoms and recurrent incontinence.

Continence Is Not Affected after Sling Revision with Transvaginal Tape Elongation for Post-Sling Voiding Dysfunction

“…For cases of persistent VD following a sling procedure, revisions such as incising or excising the sling, or performing extensive urethralysis, are typically effective. Various mid-urethral sling incision methods, including midline, unilateral, and bilateral techniques, have been reported [6][7][8][9][10]13,19,20]. However, these approaches are associated with a 9-61% risk of SUI, as indicated in studies [6][7][8][9][10]13,19,20], which also lacked long-term follow-up.…”

“…Various mid-urethral sling incision methods, including midline, unilateral, and bilateral techniques, have been reported [6][7][8][9][10]13,19,20]. However, these approaches are associated with a 9-61% risk of SUI, as indicated in studies [6][7][8][9][10]13,19,20], which also lacked long-term follow-up. When the sling is incised or excised, particularly in early incisions, the area of the urethra above the sling gap becomes a weak point, increasing the vulnerability to incontinence recurrence.…”

“…Post-sling VD causes a spectrum of symptoms ranging from irritative voiding to voiding difficulty with or without elevated post-void residual urine volume and total urinary retention [6][7][8][9][10]. In addition to these bothersome symptoms, delayed treatment may result in irreversible bladder dysfunction [11][12][13].…”

“…Various sling loosening procedures performed at a short interval were reported to resolve the problem, and have been associated with minimal morbidity [10,[16][17][18]. For refractory cases, sling revision with incision, excision of slings or extensive urethra-lysis are usually effective; however, these methods have been associated with risk of recurrent SUI in 9-61% of cases [6][7][8][9][10]13,19,20].…”

This Month in Adult Urology

“…To help elucidate, Ross et al (page 384) from Canada report on their single-center retrospective review of patients referred with chronic urinary symptoms and a history of urethral sling surgery. 4 In a cohort of 105 patients, 60% met their urodynamic definition for obstruction. Fifty-six percent of patients underwent suburethral sling excision, with improvement in storage and voiding symptoms at 6 months of 43% and 87%, respectively.…”