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Complications Following the Insertion of Two Synthetic Mid-urethral Slings and Subsequent Removal.
Low Urin Tract Symptoms. 2018 Sep; 10(3):259-265.LU

Abstract

OBJECTIVE

To determine outcomes after removal of two synthetic mid-urethral slings (MUS) at a tertiary care center.

METHODS

Following IRB approval, a retrospective chart review of non-neurogenic, symptomatic women requiring re-operation after ≥2 MUS was performed. Data reviewed by a third party included: demographics, prior anti-incontinence surgery, complications, pelvic/urinary symptoms, subsequent investigations, surgical repair and outcomes (including UDI-6/IIQ-7 questionnaires) at a minimum 6 months follow-up. Cure was defined as being continent, no dyspareunia, and no additional surgical therapy.

RESULTS

Between 2007 and 2014, 21 women met the inclusion criteria. Mean age was 57 years (range: 40-82) and mean follow-up was 30.2 months (range: 6-78). The majority of patients presented with one or more symptoms of voiding dysfunction (95%), urinary incontinence (86%), irritative voiding symptoms (62%), dyspareunia (57%), recurrent urinary tract infections (UTIs) (29%), vaginal extrusion (20%) and erosion involving the urinary tract (5%). Patients had a mean of 2 prior anti-incontinence procedures (range 2-3). Over two-thirds had a combination of retropubic and transobturator MUS. Mean number of pre-operative investigations was 3.5 (1-6) including voiding cystourethrogram, cystoscopy and urodynamics. Two patients had complete remission, 14 partial remission, and five failed. Mean postoperative total UDI-6 and IIQ-7 scores at last clinic visit were 10 (range: 0-16/SD 4.1) and 11 (range: 0-28/SD 10.3), respectively.

CONCLUSION

The management of women with suboptimal outcomes following two synthetic MUS from transvaginal excision results in modest symptomatic improvement but low permanent complete remission and frequent need for additional therapies.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Lee D
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Bacsu C
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Dillon B
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Zimmern PE
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

MeSH

AdultAgedAged, 80 and overDevice RemovalDyspareuniaFemaleHumansMiddle AgedProsthesis ImplantationQuality of LifeReoperationRetrospective StudiesSuburethral SlingsTreatment OutcomeUrinary Bladder, OveractiveUrinary Incontinence, Stress

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28657139

Citation

Lee, Dominic, et al. "Complications Following the Insertion of Two Synthetic Mid-urethral Slings and Subsequent Removal." Lower Urinary Tract Symptoms, vol. 10, no. 3, 2018, pp. 259-265.
Lee D, Bacsu C, Dillon B, et al. Complications Following the Insertion of Two Synthetic Mid-urethral Slings and Subsequent Removal. Low Urin Tract Symptoms. 2018;10(3):259-265.
Lee, D., Bacsu, C., Dillon, B., & Zimmern, P. E. (2018). Complications Following the Insertion of Two Synthetic Mid-urethral Slings and Subsequent Removal. Lower Urinary Tract Symptoms, 10(3), 259-265. https://doi.org/10.1111/luts.12175
Lee D, et al. Complications Following the Insertion of Two Synthetic Mid-urethral Slings and Subsequent Removal. Low Urin Tract Symptoms. 2018;10(3):259-265. PubMed PMID: 28657139.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Complications Following the Insertion of Two Synthetic Mid-urethral Slings and Subsequent Removal. AU - Lee,Dominic, AU - Bacsu,Chasta, AU - Dillon,Benjamin, AU - Zimmern,Philippe E, Y1 - 2017/06/28/ PY - 2016/12/04/received PY - 2017/02/12/revised PY - 2017/02/27/accepted PY - 2017/6/29/pubmed PY - 2018/12/24/medline PY - 2017/6/29/entrez KW - complications KW - double tape slings KW - female urinary incontinence KW - mesh sling SP - 259 EP - 265 JF - Lower urinary tract symptoms JO - Low Urin Tract Symptoms VL - 10 IS - 3 N2 - OBJECTIVE: To determine outcomes after removal of two synthetic mid-urethral slings (MUS) at a tertiary care center. METHODS: Following IRB approval, a retrospective chart review of non-neurogenic, symptomatic women requiring re-operation after ≥2 MUS was performed. Data reviewed by a third party included: demographics, prior anti-incontinence surgery, complications, pelvic/urinary symptoms, subsequent investigations, surgical repair and outcomes (including UDI-6/IIQ-7 questionnaires) at a minimum 6 months follow-up. Cure was defined as being continent, no dyspareunia, and no additional surgical therapy. RESULTS: Between 2007 and 2014, 21 women met the inclusion criteria. Mean age was 57 years (range: 40-82) and mean follow-up was 30.2 months (range: 6-78). The majority of patients presented with one or more symptoms of voiding dysfunction (95%), urinary incontinence (86%), irritative voiding symptoms (62%), dyspareunia (57%), recurrent urinary tract infections (UTIs) (29%), vaginal extrusion (20%) and erosion involving the urinary tract (5%). Patients had a mean of 2 prior anti-incontinence procedures (range 2-3). Over two-thirds had a combination of retropubic and transobturator MUS. Mean number of pre-operative investigations was 3.5 (1-6) including voiding cystourethrogram, cystoscopy and urodynamics. Two patients had complete remission, 14 partial remission, and five failed. Mean postoperative total UDI-6 and IIQ-7 scores at last clinic visit were 10 (range: 0-16/SD 4.1) and 11 (range: 0-28/SD 10.3), respectively. CONCLUSION: The management of women with suboptimal outcomes following two synthetic MUS from transvaginal excision results in modest symptomatic improvement but low permanent complete remission and frequent need for additional therapies. SN - 1757-5672 UR - https://www.unboundmedicine.com/medline/citation/28657139/Complications_Following_the_Insertion_of_Two_Synthetic_Mid_urethral_Slings_and_Subsequent_Removal_ L2 - https://doi.org/10.1111/luts.12175 DB - PRIME DP - Unbound Medicine ER -