Quality of life and objective outcome assessment in women with tape division after surgery for stress urinary incontinence

Abstract

BackgroundMidurethral tapes may cause long-term complications such as voiding dysfunction, groin pain, de novo urgency or mesh erosion, which necessitate a reoperation. There is a paucity of data regarding health related quality of life in patients undergoing tape removal. The aim of the study was to evaluate quality of life (QoL) and objective outcome after midurethral tape division or excision.MethodsAll patients who underwent a midurethral tape division for voiding difficulties, pain or therapy resistant de novo overactive bladder between 1999 and 2014 were invited for follow-up. A control group with a suburethral tape without division was established in a 1:2 ratio and matched for age, tape used and year of tape insertion. Patients completed the Kings´ Health Questionnaire (KHQ), Incontinence Outcome Questionnaire, Female Sexual Function Index Questionnaire and the Patient Global Impression of Improvement score.ResultsTape division or excision was performed in 32 women. Overall, 15 (60%) of 25 women who were alive were available for clinical examination and completed the questionnaires. Tape division was performed for voiding dysfunction (n = 7), overactive bladder (n = 2), mesh extrusion (n = 3) and ongoing pain (n = 3). Median time to tape division/excision was 10 months. Three women in the tape division group had undergone reoperation for stress urinary incontinence (SUI). At a median follow-up of 11 years (IQR 9–13) subjective SUI rate was 53% (8/15 women) in the tape division group and 17% (5/30) in the control group (p = 0.016), with no significant differences in objective SUI rates between groups. With regard to quality of life, the study group had significantly worse scores in the SUI related domains role limitation, physical limitation, severity measures and social limitations (KHQ) compared to the control group.ConclusionsWomen needing tape division or excision have lower SUI related QoL scores compared to controls mostly because of higher subjective SUI rates.

De novo OAB After ATOMS: An Underestimated Problem or a Rare Side Effect?

“…For female urinary incontinence surgery, we know the phenomenon of postoperative "de novo" urgency (11)(12)(13), which is generated by the introduction of foreign material in the anterior vaginal wall, paraurethral or close to the bladder neck, and which based on the literature, occurs with a probability of 9-33% (13)(14)(15)(16). The causes of this de novo urgency are in the simplest case a urinary tract infection, but usually a foreign body irritation or even a malposition with possibly consecutive perforation of the urethra or bladder neck by the foreign material (12,17). There are no differences between the retropubic and transobturator approaches of female mid-urethral slings (18).…”

“…With respect to previous radiotherapy for prostate cancer, previous urinary incontinence surgery, and transurethral resection of a urethral stricture, 25.8, 26, and 23.5% of patients were pre-treated with these measures, respectively. The average number of pads was 5.1 ± 2.9 pads/24 h, with an ICIQ-SF score averaging 16.8 ± 2.0(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)…”

Tobacco use, immunosuppressive, chronic pain, and psychiatric conditions are prevalent in women with symptomatic mesh complications undergoing mesh removal surgery

“…There is limited literature on preoperative factors which may predispose patients to mesh complications specifically, as opposed to complications from surgery in general [7]. Similarly, there are limited data regarding the outcomes of women undergoing mesh explant due to mesh complications [13]. Here, we present data from our tertiary referral center experience of pelvic floor mesh explant surgery for symptomatic mesh complications.…”

Patient satisfaction and objective outcome assessment following mid-urethral sling procedures in women with stress urinary incontinence: A prospective study

“…Over the years, the mid-urethral sling (MUS) operation has become the most common female SUI treatment owing to its long-term high success rate, safety, easiness and low complication rates is grade A for surgical treatment of MUS as the latest technical advances, which are more effective and simpler than previous anti-incontinence operations [1,4]. European Association of Urology (EAU) guidelines recently recommended Tension-free midurethral sling is grade A for surgical treatment of MUS as the latest technical advances, which are more effective and simpler than previous antiincontinence operations [5,6].…”

“…Theoretically, in a MUS operation, a tape is placed underneath the urethra, when the woman coughs, the urethra is compressed, thus preventing urine leakage. Two main methods are used to carry out this operation, either by placing a tape behind the pubic bone through groin ('transobturator'), or through the abdomen ('retropubic') [4]. Although, several studies have reported the success rate of MUS surgery for SUI, some patients experience complications following this operation such as de novo urgency or mesh erosion, recurrent SUI and postoperative voiding dysfunction (PVD) [1,2,7].…”