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Mid-urethral sling revision for mesh exposure-long-term outcomes of two surgical techniques from a comparative clinical retrospective cohort study.
BJOG. 2020 07; 127(8):1027-1033.BJOG

Abstract

OBJECTIVE

To compare vaginal closure with versus without sling excision in the management of vaginal sling exposure following mid-urethral sling (MUS).

DESIGN

Clinical retrospective cohort study.

SETTING

Tertiary urogynaecological centre in Australia.

POPULATION

Women with urodynamic stress urinary incontinence (SUI) who had a MUS (n = 2823) during 1999-2017 with a follow-up period up to December 2018. Thirty-three women (1%) had sling exposure and 31 required surgical intervention (1%).

METHODS

Clinical review with analysis of surgical database and patient records.

MAIN OUTCOME MEASURES

The primary outcome was successful closure and resolution of exposure-related symptoms without the need for re-surgery. Secondary outcomes were repeat procedure and recurrent incontinence following revision.

RESULTS

Mean follow up was 103 months. Of the 20 women with a primary excision and closure approach, 19 had successful closure. Seven of 11 women with simple vaginal closure without excision needed another surgery for recurrent mesh exposure. Recurrence of stress incontinence did not occur in any of the four who had 'successful' closure without excision. Of those who had sling division/removal without a concomitant stress continence procedure, 32% (7/22) required further surgery.

CONCLUSION

Sling excision and repair have better outcomes with less recurrence of sling exposure compared with simple closure. Following sling removal, one of three women will develop SUI recurrence and require surgery. TWEETABLE ABSTRACT: #Slingexcision &repair leads to less recurrence of exposure versus #simpleclosure for #slingmeshexposure.

Authors+Show Affiliations

Department of Urogynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia.Department of Urogynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia.Department of Urogynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32107882

Citation

Karmakar, D, et al. "Mid-urethral Sling Revision for Mesh Exposure-long-term Outcomes of Two Surgical Techniques From a Comparative Clinical Retrospective Cohort Study." BJOG : an International Journal of Obstetrics and Gynaecology, vol. 127, no. 8, 2020, pp. 1027-1033.
Karmakar D, Dwyer PL, Nikpoor P. Mid-urethral sling revision for mesh exposure-long-term outcomes of two surgical techniques from a comparative clinical retrospective cohort study. BJOG. 2020;127(8):1027-1033.
Karmakar, D., Dwyer, P. L., & Nikpoor, P. (2020). Mid-urethral sling revision for mesh exposure-long-term outcomes of two surgical techniques from a comparative clinical retrospective cohort study. BJOG : an International Journal of Obstetrics and Gynaecology, 127(8), 1027-1033. https://doi.org/10.1111/1471-0528.16149
Karmakar D, Dwyer PL, Nikpoor P. Mid-urethral Sling Revision for Mesh Exposure-long-term Outcomes of Two Surgical Techniques From a Comparative Clinical Retrospective Cohort Study. BJOG. 2020;127(8):1027-1033. PubMed PMID: 32107882.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mid-urethral sling revision for mesh exposure-long-term outcomes of two surgical techniques from a comparative clinical retrospective cohort study. AU - Karmakar,D, AU - Dwyer,P L, AU - Nikpoor,P, Y1 - 2020/02/27/ PY - 2020/01/24/accepted PY - 2020/2/29/pubmed PY - 2020/7/1/medline PY - 2020/2/29/entrez KW - Mesh KW - mesh complications KW - mid-urethral sling KW - sling exposure SP - 1027 EP - 1033 JF - BJOG : an international journal of obstetrics and gynaecology JO - BJOG VL - 127 IS - 8 N2 - OBJECTIVE: To compare vaginal closure with versus without sling excision in the management of vaginal sling exposure following mid-urethral sling (MUS). DESIGN: Clinical retrospective cohort study. SETTING: Tertiary urogynaecological centre in Australia. POPULATION: Women with urodynamic stress urinary incontinence (SUI) who had a MUS (n = 2823) during 1999-2017 with a follow-up period up to December 2018. Thirty-three women (1%) had sling exposure and 31 required surgical intervention (1%). METHODS: Clinical review with analysis of surgical database and patient records. MAIN OUTCOME MEASURES: The primary outcome was successful closure and resolution of exposure-related symptoms without the need for re-surgery. Secondary outcomes were repeat procedure and recurrent incontinence following revision. RESULTS: Mean follow up was 103 months. Of the 20 women with a primary excision and closure approach, 19 had successful closure. Seven of 11 women with simple vaginal closure without excision needed another surgery for recurrent mesh exposure. Recurrence of stress incontinence did not occur in any of the four who had 'successful' closure without excision. Of those who had sling division/removal without a concomitant stress continence procedure, 32% (7/22) required further surgery. CONCLUSION: Sling excision and repair have better outcomes with less recurrence of sling exposure compared with simple closure. Following sling removal, one of three women will develop SUI recurrence and require surgery. TWEETABLE ABSTRACT: #Slingexcision &repair leads to less recurrence of exposure versus #simpleclosure for #slingmeshexposure. SN - 1471-0528 UR - https://www.unboundmedicine.com/medline/citation/32107882/Mid_urethral_sling_revision_for_mesh_exposure_long_term_outcomes_of_two_surgical_techniques_from_a_comparative_clinical_retrospective_cohort_study_ L2 - https://doi.org/10.1111/1471-0528.16149 DB - PRIME DP - Unbound Medicine ER -