Urgency Incontinence before and after Revision of a Synthetic Mid Urethral Sling

Abstract

Patients presenting with new or worsening urgency urinary incontinence after sling placement were more likely to undergo delayed revision compared to those presenting with obstructive voiding symptoms. There is a high rate of bothersome persistent and de novo urgency incontinence after sling revision. Patient expectations should be managed accordingly before sling revision.

Management of mesh complications following surgery for stress urinary incontinence or pelvic organ prolapse: a systematic review

“…Three studies concerned women specifically referred for pain, two studies concerned women referred for vaginal complications, and one study concerned women referred for urinary complications . No studies in women who were referred specifically for bowel complications were identified.…”

“…Only four studies specified that women underwent initial mesh surgery for POP, and eight studies specified that the initial mesh surgery was for SUI . The remaining studies included women who had initial mesh surgery for POP and/or SUI, but did not report outcomes separately for these women.…”

“…One study included women who had been referred for urinary complications (voiding symptoms) and had initially undergone synthetic midurethral mesh surgery for SUI . Following mesh revision surgery, 23.5 and 78.9% of women had the complete resolution of urge urinary incontinence and obstructive voiding symptoms, respectively; however, newly reported urge incontinence and newly reported SUI developed in 43.6 and 35.5% of women, respectively, with only 22.2% of women reporting that they were satisfied or very satisfied with their initial midurethral mesh procedure …”

“…The available data suggest that the injury rate is low, with all studies reporting rates of less than 4% for bladder, urethra, or bowel injury during surgery . The injury rate in half of these studies was 1% or less . One study reported that 3% of women required a blood transfusion during surgery …”

“…Few of the included studies directly compared complete mesh removal with partial removal; however, the evidence suggests that complete rather than partial mesh removal results in an increased risk of experiencing recurrent urinary complications, and this was shown in studies where women had originally had mesh surgery for SUI or POP …”