Urethral Distortion After Placement of Synthetic Mid Urethral Sling

Murray, Sunshine; Haverkorn, Rashel; Koch, Yvonne; Lemack, Gary E.; Zimmern, Philippe E.

doi:10.1016/j.juro.2010.11.066

Cited by 20 publications

(11 citation statements)

References 25 publications

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“…This can help to identify iatrogenic bladder outlet obstruction (BOO) or de novo or persistent detrusor overactivity. Videourodynamics (VUDS) may also be helpful as it can help to identify urethral narrowing or kinking and associated proximal urethral dilation at the level of the MUS during a sustained detrusor contraction [37,38].…”

Section: Delayed Post-operative Complications Diagnostic Evaluationmentioning

confidence: 99%

Evaluation and Management of Mid-Urethral Sling Complications

Brown

Cohn

Kaufman

et al. 2016

Curr Bladder Dysfunct Rep

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Currently, a mid-urethral sling is the standard of care for the treatment of female stress urinary incontinence. However, complications can occur that are unique to polypropylene mesh such as mesh exposure, perforation, or contracture. Other complications such as de novo urgency and/or urgency urinary incontinence (UUI), urinary tract infection, and/or urinary obstruction can also occur. The diagnosis of these complications requires a high index of suspicion, and treatment is critical as these complications can be quite morbid. As such, this review will discuss the most recent literature regarding the intraoperative and post-operative evaluation and management of mid-urethral sling complications.

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Section: Delayed Post-operative Complications Diagnostic Evaluationmentioning

confidence: 99%

Evaluation and Management of Mid-Urethral Sling Complications

Brown

Cohn

Kaufman

et al. 2016

Curr Bladder Dysfunct Rep

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show abstract

“…Variation in technique of placement and "tensioning" of slings can play a role in the causation of postoperative obstruction of the bladder neck. Sonographic findings of more proximal sling positioning and voiding cystourethrogram findings of urethral distortion have both been associated with higher postoperative detrusor pressures, higher post-void residual volumes, and decreased maximum flow rates, all components proven to contribute to BOO [23,24]. Regarding BOO after sling procedures, postoperative factors such as mesh erosion and significant pelvic organ prolapse may also have a role in urethral obstruction postoperatively.…”

Section: Incidence and Etiologymentioning

confidence: 99%

Bladder Outlet Obstruction After Incontinence Surgery

Brucker

Malacarne

2016

Curr Bladder Dysfunct Rep

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Stress urinary incontinence (SUI) is said to effect up to 80 % of all women who complain of some type of urinary leakage. As education about the diagnosis and treatment of SUI becomes more widespread, there is a need for understanding the efficacy and potential complications of the therapies used to treat this condition. It is widely accepted that the gold standard for treatment of SUI is mid-urethral sling (MUS). One significant complication of the MUS procedure is subsequent bladder outlet obstruction (BOO). We review the incidence and etiology of BOO following MUS and hope this document can be used as a guide for identifying patients who may be affected by postsurgical BOO. Additionally, we discuss modalities for achieving a timely and accurate diagnosis and highlight recent evidence regarding the various applications of urodynamic studies, when concerned for BOO. Lastly, various managements of this complication are discussed. This chapter serves as a comprehensive overview of BOO after incontinence procedures, highlighting the recent research contributions, which have enhanced our understanding of this potential complication when treating SUI.

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“…It is actually the lateral attachments of the urethra which provide support and are contiguous with support of the vagina [9]. The mid-urethral sling demonstrated promising early success but leaves potential for long-term voiding dysfunction in addition to the short-term rates of extrusion, dyspareunia, erosion, pain along the tape extension arms, and at times irreversible sequelae despite attempts at removal [34,35]. As a later spinoff, the single incision mini-slings were introduced with the intention to avoid certain risks associated with the retropubic and transobturator approaches.…”

Section: Chronology Of Proceduresmentioning

confidence: 99%

“…Urethral ultrasound studies have demonstrated dynamic kinking of the urethra accompanied by a rise in intra-abdominal pressure during stress maneuvers after mid-urethral sling placement, with a higher rate of kinking noted after retropubic (86.9 %) compared to the transobturator (23.9 %) approach [34]. This dynamic kinking seems to be the primary mechanism of action of the mid-urethral sling, both at rest and during stress [35]. Is it really necessary to kink the urethra to achieve continence?…”

Section: Urethral Kinking After Slingmentioning

confidence: 99%