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Disabling complications with slings for managing female stress urinary incontinence.
BJU Int. 2008 Aug; 102(3):333-6.BI

Abstract

OBJECTIVE

To report an increase in the referral of patients with disabling complications after the failure of conservative therapy, their presentation, final surgical management and clinical outcome, following the use of non-autologous slings (NAS), currently the primary surgical procedure for managing stress urinary incontinence (SUI) in women.

PATIENT AND METHODS

Thirty-eight patients (mean age 64 years) required surgical management for disabling complications after placing a NAS for SUI. Sling types were synthetic (25), xenografts (six) and allografts (four). Twenty (53%) patients presented with bladder outlet obstruction, 13 (34%) with sling erosion, three (8%) with worsened SUI, and two (5%) with unobstructive severe urgency and frequency.

RESULTS

The sling was dissected and incised with no complication in 19 of 20 patients. One had a posterior urethral defect during sling dissection. Twelve patients (60%) acquired normal voiding and were continent. Among the 13 patients who had the sling dismantled and urethrolysis, two had recurrent or persistent SUI, two de-novo urgency/frequency and one developed osteitis pubis. Three patients with disabling SUI received a pubovaginal sling placed proximal to the bladder neck, and had an overall improvement in their urinary control with no retention. Two unobstructed patients with urgency and frequency did not improve with anticholinergic medication and pelvic floor therapy, and are now candidates for botulinum toxin injection or neurostimulation.

CONCLUSIONS

The complication rate with periurethral NAS for managing SUI in females is substantial. Patients with refractory urgency/frequency after the sling need a complete evaluation with cystoscopy and video-urodynamics. Obstruction and erosion are the commonest problems and require surgical correction.

Authors+Show Affiliations

Division of Urology, University of South Florida, Tampa, FL 33612-9497, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18384633

Citation

Ordorica, Raul, et al. "Disabling Complications With Slings for Managing Female Stress Urinary Incontinence." BJU International, vol. 102, no. 3, 2008, pp. 333-6.
Ordorica R, Rodriguez AR, Coste-Delvecchio F, et al. Disabling complications with slings for managing female stress urinary incontinence. BJU Int. 2008;102(3):333-6.
Ordorica, R., Rodriguez, A. R., Coste-Delvecchio, F., Hoffman, M., & Lockhart, J. (2008). Disabling complications with slings for managing female stress urinary incontinence. BJU International, 102(3), 333-6. https://doi.org/10.1111/j.1464-410X.2008.07608.x
Ordorica R, et al. Disabling Complications With Slings for Managing Female Stress Urinary Incontinence. BJU Int. 2008;102(3):333-6. PubMed PMID: 18384633.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Disabling complications with slings for managing female stress urinary incontinence. AU - Ordorica,Raul, AU - Rodriguez,Alejandro R, AU - Coste-Delvecchio,Fernando, AU - Hoffman,Mitchell, AU - Lockhart,Jorge, Y1 - 2008/04/02/ PY - 2008/4/4/pubmed PY - 2008/9/4/medline PY - 2008/4/4/entrez SP - 333 EP - 6 JF - BJU international JO - BJU Int VL - 102 IS - 3 N2 - OBJECTIVE: To report an increase in the referral of patients with disabling complications after the failure of conservative therapy, their presentation, final surgical management and clinical outcome, following the use of non-autologous slings (NAS), currently the primary surgical procedure for managing stress urinary incontinence (SUI) in women. PATIENT AND METHODS: Thirty-eight patients (mean age 64 years) required surgical management for disabling complications after placing a NAS for SUI. Sling types were synthetic (25), xenografts (six) and allografts (four). Twenty (53%) patients presented with bladder outlet obstruction, 13 (34%) with sling erosion, three (8%) with worsened SUI, and two (5%) with unobstructive severe urgency and frequency. RESULTS: The sling was dissected and incised with no complication in 19 of 20 patients. One had a posterior urethral defect during sling dissection. Twelve patients (60%) acquired normal voiding and were continent. Among the 13 patients who had the sling dismantled and urethrolysis, two had recurrent or persistent SUI, two de-novo urgency/frequency and one developed osteitis pubis. Three patients with disabling SUI received a pubovaginal sling placed proximal to the bladder neck, and had an overall improvement in their urinary control with no retention. Two unobstructed patients with urgency and frequency did not improve with anticholinergic medication and pelvic floor therapy, and are now candidates for botulinum toxin injection or neurostimulation. CONCLUSIONS: The complication rate with periurethral NAS for managing SUI in females is substantial. Patients with refractory urgency/frequency after the sling need a complete evaluation with cystoscopy and video-urodynamics. Obstruction and erosion are the commonest problems and require surgical correction. SN - 1464-410X UR - https://www.unboundmedicine.com/medline/citation/18384633/Disabling_complications_with_slings_for_managing_female_stress_urinary_incontinence_ DB - PRIME DP - Unbound Medicine ER -