Recurrent Incontinence After Transvaginal Partial Sling Excision in Patients with Prior Mid-Urethral Sling

Shapiro, Robert E.; Dueñas-García, Omar Felipe; Vallejo, Manuel C.; Trump, Tyler; Sufficool, Makenzy; Zaslau, Stanley

doi:10.2147/rru.s281697

Cited by 3 publications

(5 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nevertheless, overall, there was no difference found between partial or total mesh removal in regard to improvement in pain outcomes in all four studies. Nine [16][17][18]38,40,47,[51][52][53] single-group studies that evaluated partial removal all demonstrated an associated improvement in pain outcomes; these outcome measures were varied and included the FSFI (Female Sexual Function Index), the UDI-6 (Urogenital Distress Index), subjective reports, and a numeric pain scale. Two 45,46 single-group studies looking at total mesh removal also report an associated improvement in pain outcome measures.…”

Section: Resultsmentioning

confidence: 99%

“…Of the four patients with persistent bladder outlet obstruction, mesh sling transection was performed 4-8 months later with 100% resolution. Comparative and single-group studies 3,14,17,19,20,23,[26][27][28][29][30][31][32]39,41,[43][44][45]52,54 demonstrated no difference in bladder outlet obstruction outcomes between total and partial mesh excision; both techniques showed an associated improvement in bladder outlet obstruction symptoms.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Surgical Removal of Midurethral Sling in Women Undergoing Surgery for Presumed Mesh-Related Complications

Doyle

Grimes

Balk

et al. 2022

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

To assess whether some, or all, of the mesh needs to be removed when a midurethral sling is removed for complications.DATA SOURCES: A systematic review and meta-analysis was conducted. MEDLINE, Cochrane, and ClinicalTrials. gov databases from January 1, 1996, through May 1, 2021, were searched for articles that met the eligibility criteria with total, partial, or a combination of anti-incontinence mesh removal. METHODS OF STUDY SELECTION:All study designs were included (N$10), and a priori criteria were used for acceptance standards. Studies were extracted for demographics, operative outcomes, and adverse events. Meta-analysis was performed when possible.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Surgical Removal of Midurethral Sling in Women Undergoing Surgery for Presumed Mesh-Related Complications

Doyle

Grimes

Balk

et al. 2022

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

show abstract

“…The probability of being incontinence-free posturethral sling excision was 56% (95% CI 41, 69) at 30 months, which is higher than previous studies which have reported recurrent incontinence in between 13% and 28%. 14,22,23 The reasons for preserved incontinence post-partial sling excision is hypothesized to be secondary to some remaining support from the lateral arms of the sling (which remain in situ) as well as suburethral scar tissue. 22 Although most cases of recurrent incontinence were mild (<2 pads per day), the survival probability for redo incontinence surgery was 75% (95% CI 54, 87) at 30 months and the potential need for reoperation should be discussed with patients.…”

Section: Discussionmentioning

confidence: 99%

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

Ross

Avvakoumova

Yassein³

et al. 2023

Journal of Urology

View full text Add to dashboard Cite

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.

show abstract

“…High rates of loss to follow‐up (60%−70%) have been common in studies reporting outcomes after mesh excision 8,12 . A review of the literature revealed commonality between other studies—frequently, studies reporting outcomes of stress incontinence after mesh excision typically carry heterogenous groups of MUT routes, report outcomes over a short period of time, and are limited to vaginal excisions 8,9,20–23 . These rates cannot be generalized to those undergoing TETOT, in the long‐term.…”

Section: Discussionmentioning

confidence: 99%

“…8,12 A review of the literature revealed commonality between other studies-frequently, studies reporting outcomes of stress incontinence after mesh excision typically carry heterogenous groups of MUT routes, report outcomes over a short period of time, and are limited to vaginal excisions. 8,9,[20][21][22][23] These rates cannot be generalized to those undergoing TETOT, in the longterm. Rates of worsening and new stress incontinence provide clinicians with essential information to counsel women.…”

Section: Stress Incontinencementioning

confidence: 99%

Clinical outcomes after total excision of transobturator tape inserted for treatment of stress urinary incontinence

Abbas

Virdee

Basu

et al. 2023

Neurourology and Urodynamics

View full text Add to dashboard Cite

Introduction: Midurethral tapes (MUTs) were the most common surgical treatment for stress urinary incontinence (SUI) between 2008 and 2017.Transobturator tapes were introduced as a novel way to insert MUTs. Some women have experienced life-changing complications, and opt to undergo a total excision of transobturator tape (TETOT). There is a paucity in evidence about the outcomes of TETOT, which is a complex operation. This study aims to report clinical outcomes of all women who underwent TETOT in a specialist mesh center. Methods: All women between 2017 and 2022 who underwent TETOT in one mesh center were reviewed. Background demographics and preoperative symptoms were recorded retrospectively. Outcome data were collected using patient global impression of improvement (PGI-I) scales via telephone review and analyzed using SPSS 25. Results: Forty-five women underwent telephone review in May 2022, on average 27.9 months (range: 3−60) after TETOT. Mean age was 55 and body mass index (BMI): 30; 82% were postmenopausal, 20% were smokers, and 73.3% had recurrent SUI before excision. Indications for excision were infection (4%), vaginal exposure (24%), urethral perforation (9%), and chronic pain not associated with other complications (60%). Two women with recurrent SUI opted for a concomitant fascial sling; both reported a PGI of "very much improved" regarding SUI postoperatively. Only 12 women (26.5%) did not have SUI before excision; of these 9 (75%) reported new SUI postoperatively. Pain improved for 57.8%, but worsened for 24.4%. Although not statistically significant (p = 0.055), more women who underwent TETOT for pain alone reported worsening pain than those with pain with an

show abstract

Recurrent Incontinence After Transvaginal Partial Sling Excision in Patients with Prior Mid-Urethral Sling

Cited by 3 publications

References 19 publications

Surgical Removal of Midurethral Sling in Women Undergoing Surgery for Presumed Mesh-Related Complications

Surgical Removal of Midurethral Sling in Women Undergoing Surgery for Presumed Mesh-Related Complications

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

Clinical outcomes after total excision of transobturator tape inserted for treatment of stress urinary incontinence

Contact Info

Product

Resources

About