Salvage autologous fascial sling after failed synthetic midurethral sling: Greater than 3‐year outcomes

Petrou, Steven; Davidiuk, Andrew J.; Rawal, Bhupendra; Arnold, Michelle; Thiel, David D.

doi:10.1111/iju.13003

Cited by 17 publications

(11 citation statements)

References 13 publications

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“…At 74 months of followup, 52% of patients remained dry. 15 It is our opinion that patients with a mild to moderate degree of leakage benefit from repeat RPR MUS, and those with more severe leakage are more likely to benefit from PVS (Fig. 1).…”

Section: Surgical Interventionmentioning

confidence: 95%

Management of patients with stress urinary incontinence after failed midurethral sling

Kavanagh¹,

Sanaee²,

Carlson³

et al. 2017

CUAJ

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Surgical failure rates after midurethral sling (MUS) procedures are variable and range from approximately 8-57% at five years of followup. The disparity in long-term failure rates is explained by a lack of long-term followup and lack of a clear definition of what constitutes failure. A recent Cochrane review illustrates that no high-quality data exists to recommend or refute any of the different management strategies for recurrent or persistent stress urinary incontinence (SUI) after failed MUS surgery. Clinical evaluation requires a complete history, physical examination, and establishment of patient goals. Conservative treatment measures include pelvic floor physiotherapy, incontinence pessary dish, commercially available devices (Uresta ® , Impressa ® ), or medical therapy. Minimally invasive therapies include periurethral bulking agents (bladder neck injections) and sling plication. Surgical options include repeat MUS with or without mesh removal, salvage autologous fascial sling or Burch colposuspension, or salvage artificial urinary sphincter insertion. In this paper, we present the available evidence to support each of these approaches and include the management strategy used by our review panel for patients that present with SUI after failed midurethral sling. IntroductionWith shorter recovery times and comparable efficacy, the midurethral sling (MUS) has surpassed the Burch colposuspension as the "gold standard" treatment for stress urinary incontinence (SUI); however, some patients will not be cured after MUS surgery and currently, there is no consensus on how to manage these patients. This constitutes a major problem not only for the patient, but also for the clinician who is faced with choosing a second surgical procedure with the best possible outcome. Options can include placement of a second synthetic MUS or an autologous sling, such as a pubovaginal sling (PVS). Furthermore, there is no consensus about whether the previously inserted MUS should be excised or if a second tape should simply be placed over the existing tape. The decision on whether to use a sling inserted via an alternative route (retropubic vs. transobturator) also has not been addressed. ranging from 62-98% in the TOR group and from 71-97% in the RPR group. Fewer trials reported medium-term (one to five years) and longer-term (over five years) data, but subjective cure was similar between the groups (RR 0.97; 95% CI 0.87-1.09; five trials, 683 women; and RR 0.95; 95% CI 0.80-1.12; four trials, 714 women). In the long-term, subjective cure rates were similar and ranged from 43-92% in the TOR group and from 51-88% in the RPR group. 2The disparity in long-term failure rates is explained by a lack of long-term followup and lack of a clear definition of what constitutes failure. In the above Cochrane review, only four of 55 included studies actually provided information regarding leakage and adverse events at five years. Additionally, "failure" may be defined differently. Failure can include: persistence of bothersome SUI; cure...

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Section: Surgical Interventionmentioning

confidence: 95%

Management of patients with stress urinary incontinence after failed midurethral sling

Kavanagh¹,

Sanaee²,

Carlson³

et al. 2017

CUAJ

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“…Mesh excision did not relate to worse outcomes (p=0.013) [50]. Another retrospective study of 21 patients who performed PVS after failed A c c e p t e d A r t i c l e MUS resulted in no statistical impact on whether concomitant sling excision (n=8) or not (n=13) (p=0.62) [51]. However, it seems reasonable to remove the first sling if repeat surgery is necessary due to the complications related to mesh exposure, pain, and postoperative voiding difficulty.…”

Section: Concurrent Excision or Removal Of The Prior Slingmentioning

confidence: 97%

“…The cure rates of PVS using autologous fascia as second-line management have been reported to be 60-80% [49][50][51][52][53]. A retrospective study of 66 patients (16 pure SUI vs. 50 mixed incontinence) who got an autologous PVS after failed MUS reported that 69.7% of the cure of SUI.…”

Section: Pubovaginal Sling With Autologous Rectus Fasciamentioning

confidence: 99%

“…16 patients (76.2%) were considered to success by the Patient Global Impression of Improvement questionnaire for a median follow up of 74 months. Concurrent sling excision, mixed urinary incontinence, age, length of follow up, and first surgery type (RP vs. TO) had no statistical impact [51]. In the studies comparing PVS with RP sling, some reported similar success rates and complications between two groups [52], while others noted that PVS had a higher surgical success rate and more complications related to postoperative voiding difficulty [53,54].…”

Section: A C C E P T E D a R T I C L Ementioning

confidence: 99%

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Second-Line Surgical Management After Midurethral Sling Failure

Kwon

Kim

2021

Int Neurourol J

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Currently, midurethral sling is widely used as a standard treatment in stress urinary incontinence (SUI) patients. According to several studies, the failure rate of midurethral sling (MUS) has been reported to be approximately 5-20%. In general, the sling failure can be defined as the state that SUI persists even after the surgery or that incontinence is improved temporarily and then recurs. Additionally, it can be widely regarded as a failure that the cases requiring secondary surgery due to mesh exposure, postoperative voiding difficulty, de novo urgency/urge incontinence, and severe postoperative pain, etc.Because of the lack of a large-scale study with high quality, there has been no clear guideline for second-line management yet. To date, transurethral bulking agent injection, tape shortening, repeat MUS, pubovaginal sling (PVS) using autologous fascia, and Burch colposuspension are available options for second-line surgery. Repeat MUS is the most widely used method as a second-line surgery at present. Bulking agent injection has lower durability and efficacy compared to other treatments. Tape shortening demonstrates a relatively lower success rate but comparable outcome if the period from first treatment to relapse is short. In patients with intrinsic sphincter deficiency (ISD), PVS and retropubic (RP) MUS can be considered first as second-line management because of higher success rate compared to other treatments. When revision or reoperation is required due to prior meshrelated complications, PVS or colposuspension, which is performed without a synthetic mesh, is appropriate for the second-line surgery. For the patient with detrusor underactivity, the readjustable sling can be a better option because of the high risk of postoperative voiding dysfunction in PVS or RP sling.

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“…75 The use of autologous fascial slings for recurrent SUI have reported success rates of 52% to 91%. 76,77 They are more appropriate for women with severe leakage or ISD as they can be tensioned to increase urethral resistance (as opposed to s-MUS, which must be inserted tension free) and for those who have failed more than one tape. 61 AUS insertion in women is indicated for patients with severe SUI due to ISD.…”

Section: Case Iib: Mesh Complication Following Insertion Of Tvt-omentioning

confidence: 99%

Female stress urinary incontinence MDT

Sihra

Kujawa

Solomon

et al. 2019

Journal of Clinical Urology

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The management of female stress urinary incontinence (SUI) has come under scrutiny in recent years following growing reports of mesh-related complications. Patients require thorough evaluation and management as part of a multidisciplinary team, and extensive counselling about the surgical treatment options is imperative. There is no clear consensus on the optimal management of the complex group of patients with mesh-related complications or recurrent SUI. We present two cases of female SUI to highlight the key factors to be considered when managing these patients. Level of evidence: Level 5.

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Salvage autologous fascial sling after failed synthetic midurethral sling: Greater than 3‐year outcomes

Cited by 17 publications

References 13 publications

Management of patients with stress urinary incontinence after failed midurethral sling

Management of patients with stress urinary incontinence after failed midurethral sling

Second-Line Surgical Management After Midurethral Sling Failure

Female stress urinary incontinence MDT

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