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Long-Term Outcomes After Repair of Transurethral Perforation of Midurethral Sling.
Female Pelvic Med Reconstr Surg. 2016 Jul-Aug; 22(4):272-5.FP

Abstract

OBJECTIVES

The literature lacks long-term evaluation of outcomes after repair of transurethral midurethral sling (MUS) perforation.

METHODS

We prospectively followed 5 patients undergoing repair of urethral perforation (International Continence Society-International Urogynecological Association classification 4B) after MUS (mean follow-up, 54 months). Outcomes assessment was composed of validated measures of urinary (International Consultation on Incontinence Questionnaire [ICIQ]-Female Lower Urinary Tract Symptoms), vaginal (ICIQ-Vaginal Symptoms), and quality of life (Incontinence Impact Questionnaire, Short Form) symptoms.

RESULTS

Five patients underwent MUS (4 transobturator, 1 retropubic) with a mean of 41 months before referral. Primary referring complaints composed of hematuria (2), weak stream (2), and urgency (1). All but 1 patient reported transient urinary retention requiring catheterization after initial sling placement. Each patient underwent transvaginal sling excision and repair of urethral injury. Four of 5 patients experienced persistent postoperative stress urinary incontinence. Before final assessment, further treatment included observation, physical therapy, and autologous fascial sling in 1, 2, and 2 patients, respectively. ICIQ-Female Lower Urinary Tract Symptoms, ICIQ-Vaginal Symptoms, and Incontinence Impact Questionnaire, Short Form, assessment failed to demonstrate statistically significant improvements in comparison of baseline and multiple time point (6-week, 12-month, 54-month) assessments during long-term follow-up (P > 0.05).

CONCLUSIONS

Urethral perforation represents a significant complication after MUS placement. Many patients continue to have incontinence despite the use of physical therapy/salvage sling placement. Furthermore, subjective outcomes and quality of life do not seem to improve over time. Because of the rarity of urethral perforation, our small series is notable given the absence of reported data that include prospective, long-term follow-up with validated questionnaire evaluation.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Colhoun A
From the *Virginia Commonwealth University School of Medicine; and †Virginia Urology Center for Incontinence and Pelvic Floor Reconstruction, Richmond, VA.
Rapp DE
No affiliation info available

MeSH

AdultDevice RemovalFemaleFollow-Up StudiesHumansLower Urinary Tract SymptomsMiddle AgedProspective StudiesQuality of LifeSuburethral SlingsSurveys and QuestionnairesTreatment OutcomeUrethraUrinary Incontinence, Stress

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27054792

Citation

Colhoun, Andrew, and David E. Rapp. "Long-Term Outcomes After Repair of Transurethral Perforation of Midurethral Sling." Female Pelvic Medicine & Reconstructive Surgery, vol. 22, no. 4, 2016, pp. 272-5.
Colhoun A, Rapp DE. Long-Term Outcomes After Repair of Transurethral Perforation of Midurethral Sling. Female Pelvic Med Reconstr Surg. 2016;22(4):272-5.
Colhoun, A., & Rapp, D. E. (2016). Long-Term Outcomes After Repair of Transurethral Perforation of Midurethral Sling. Female Pelvic Medicine & Reconstructive Surgery, 22(4), 272-5. https://doi.org/10.1097/SPV.0000000000000273
Colhoun A, Rapp DE. Long-Term Outcomes After Repair of Transurethral Perforation of Midurethral Sling. Female Pelvic Med Reconstr Surg. 2016 Jul-Aug;22(4):272-5. PubMed PMID: 27054792.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-Term Outcomes After Repair of Transurethral Perforation of Midurethral Sling. AU - Colhoun,Andrew, AU - Rapp,David E, PY - 2016/4/8/entrez PY - 2016/4/8/pubmed PY - 2017/11/29/medline SP - 272 EP - 5 JF - Female pelvic medicine & reconstructive surgery JO - Female Pelvic Med Reconstr Surg VL - 22 IS - 4 N2 - OBJECTIVES: The literature lacks long-term evaluation of outcomes after repair of transurethral midurethral sling (MUS) perforation. METHODS: We prospectively followed 5 patients undergoing repair of urethral perforation (International Continence Society-International Urogynecological Association classification 4B) after MUS (mean follow-up, 54 months). Outcomes assessment was composed of validated measures of urinary (International Consultation on Incontinence Questionnaire [ICIQ]-Female Lower Urinary Tract Symptoms), vaginal (ICIQ-Vaginal Symptoms), and quality of life (Incontinence Impact Questionnaire, Short Form) symptoms. RESULTS: Five patients underwent MUS (4 transobturator, 1 retropubic) with a mean of 41 months before referral. Primary referring complaints composed of hematuria (2), weak stream (2), and urgency (1). All but 1 patient reported transient urinary retention requiring catheterization after initial sling placement. Each patient underwent transvaginal sling excision and repair of urethral injury. Four of 5 patients experienced persistent postoperative stress urinary incontinence. Before final assessment, further treatment included observation, physical therapy, and autologous fascial sling in 1, 2, and 2 patients, respectively. ICIQ-Female Lower Urinary Tract Symptoms, ICIQ-Vaginal Symptoms, and Incontinence Impact Questionnaire, Short Form, assessment failed to demonstrate statistically significant improvements in comparison of baseline and multiple time point (6-week, 12-month, 54-month) assessments during long-term follow-up (P > 0.05). CONCLUSIONS: Urethral perforation represents a significant complication after MUS placement. Many patients continue to have incontinence despite the use of physical therapy/salvage sling placement. Furthermore, subjective outcomes and quality of life do not seem to improve over time. Because of the rarity of urethral perforation, our small series is notable given the absence of reported data that include prospective, long-term follow-up with validated questionnaire evaluation. SN - 2154-4212 UR - https://www.unboundmedicine.com/medline/citation/27054792/Long_Term_Outcomes_After_Repair_of_Transurethral_Perforation_of_Midurethral_Sling_ DB - PRIME DP - Unbound Medicine ER -