30-Day Morbidity and Reoperation Following Midurethral Sling: Analysis of 8772 Cases Using a National Prospective Database

Cohen, Andrew J.; Packiam, Vignesh T.; Nottingham, Charles U.; Alberts, Blake; Faris, Sarah; Bales, Gregory T.

doi:10.1016/j.urology.2016.04.043

Cited by 19 publications

(10 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6,14 UTIs may be more common in patients older than 65, those with a body mass index (BMI) >40, those who are admitted to hospital, and when the implantation is performed by a gynecological surgeon.…”

Section: Urinary Tract Infectionmentioning

confidence: 99%

“…6,7,9 The exit sites in the groin or suprapubic region may present with localized erythema, warmth, and pain, and this may be associated with a purulent exudate. Systemic antibiotic treatment and debridement to ensure there is no mesh at the surface is sufficient in most instances.…”

Section: Surgical Site Infections and Vaginal Wall Concernsmentioning

confidence: 99%

“…Studies report that 4% of patients develop one or more complications associated with their MUS procedure. 6,7 Herein, we review the prevention, diagnosis, and management of the potential intraoperative, early (<90 days) postoperative, and late (>90 days) postoperative risks of MUS implantation.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prevention, diagnosis, and management of midurethral mesh sling complications

Hengel

Carlson

Baverstock

2017

CUAJ

View full text Add to dashboard Cite

Midurethral slings (MUS) are a proven effective treatment option for stress urinary incontinence (SUI) and have become the gold standard in most centres in North America. MUS implantation can be associated with risks that are common to all anti-incontinence surgeries, and others which are unique. This article reviews the intraoperative and the early and late postoperative risks associated with these procedures, with insights into their prevention, diagnosis, and management drawn from the literature and expert opinion. In most cases, careful patient counselling before and after surgery, along with meticulous surgical technique, can mitigate risk and patient concern. Even in the best of hands, however, complications will occur, so surgeons must have a high index of suspicion and a low threshold to investigate. IntroductionStress urinary incontinence (SUI) affects a large proportion of females, with some studies estimating between 4-35% of the adult female population.1,2 Midurethral slings (MUS) are an effective treatment option for SUI after conservative treatments like pessaries and pelvic floor physiotherapy have been attempted.2,3 MUS procedures have high subjective cure rates ranging from 64-97% at 10-year followup. 2,4,5 Despite their documented efficacy in treating SUI, these devices can be associated with various complications. Studies report that 4% of patients develop one or more complications associated with their MUS procedure.6,7 Herein, we review the prevention, diagnosis, and management of the potential intraoperative, early (<90 days) postoperative, and late (>90 days) postoperative risks of MUS implantation. Intraoperative complicationsIntraoperative complications are the result of injury to adjacent structures either during the dissection to place the trocar or during passage of the trocar itself. Many different MUS products are available, including top-down and bottom-up retropubic devices, and outside-in or inside-out transobturator devices. The decision on which device to use may be based on which device a surgeon trained on, which device is available at his or her facility, and occasionally which device is most indicated for a particular patient (i.e., retropubic vs. transobturator). Most surgeons have a preferred device and approach with which they have advanced along the learning curve, a critical point in minimizing complications. 8 In an article by Hilton and Rose, they report that "whilst seductively simple," the MUS tapes are blind and hard to teach. They suggest that to achieve a <5% bladder perforation rate, a surgeon must complete 20-80 cases. 8 Bladder perforationIntraoperative bladder perforation represents the most common intraoperative complication in MUS surgery and occurs when the trocar is inadvertently inserted into the bladder. Based on the Cochrane review by Ford, this risk is much higher with retropubic (4.5%) vs. transobturator devices (0.6%). 5 It is recommended that surgeons use a cystoscope sheath or catheter with stylet to deflect the bladder neck to the side ...

show abstract

Section: Urinary Tract Infectionmentioning

confidence: 99%

Section: Surgical Site Infections and Vaginal Wall Concernsmentioning

confidence: 99%

See 1 more Smart Citation

Prevention, diagnosis, and management of midurethral mesh sling complications

Hengel

Carlson

Baverstock

2017

CUAJ

View full text Add to dashboard Cite

show abstract

“…Recently, a published detailed analysis of 8772 patients from the National Prospective Database who had undergone MUS procedures focused on the 30-day morbidity and reoperation rate. This was stratified additionally by the specialty of performing surgeon (urologists and gynecologists) [ 8 ]. The authors found that the overall 30-day rate of any complications was as low as 3.52%.…”

Section: Introductionmentioning

confidence: 99%

Transobturator midurethral sling: What should patients expect after surgery?

et al. 2017

View full text Add to dashboard Cite

Introduction and hypothesisMidurethral sling (MUS) surgeries are minimally invasive procedures; however, they are not free of postoperative complications. The aim of the study was to assess the occurrence of lower urinary tract symptoms (LUTS) (urgency, nocturia, frequency, splitting/spraying, hesitancy, terminal dribbling, and subjective feeling of postvoid residual) in patients suffering from stress (SUI) or mixed (MUI) urinary incontinence with a predominant SUI component before and after transobturator MUS placement.MethodsThe study group consisted of 88 women with SUI and 18 with MUI who underwent transobturator MUS. All participants were questioned with a self-developed questionnaire before and after surgery regarding the presence of LUTS.ResultsSeven days after surgery, 62 patients (58.5%) noted voiding and postmicturition symptoms, whereas 67 (63.2%) reported problems in storage. The more commonly reported LUTS at week 1 after surgery were urgency (52.8%), splitting/spraying (41.5%), and feeling of incomplete bladder emptying (34.0%). Patients perceived that splitting/spraying was the most bothersome. After 6 months, the most common LUTS reported were hesitancy (14.1%), terminal dribbling (10.4%), and splitting/spraying (9.4%). We noticed a decrease in the number of urgency episodes >2.7 times (p < 0.001) compared with baseline. After 6 months, 97 (91.5%) patients reported the lack of incontinence episodes.ConclusionsA vast majority of patients after MUS suffer from LUTS in the early postoperative period; however, the majority of undesired symptoms resolve spontaneously within the first 6 months postsurgery.

show abstract

“…1 In this article, Hengel et al cite a 4% incidence of patients developing one or more complications within 30 days of their MUS procedure. 7,8 Novara et al 9 reported a rate of 3.2% for any secondary surgery after MUS in a large meta-analysis. Welk et al 10 published the results of a cohort study of 59 887 women who underwent MUS procedures in Ontario from 2002-2012.…”

mentioning

confidence: 99%

Midurethral sling complications

Herschorn

2017

CUAJ

View full text Add to dashboard Cite

30-Day Morbidity and Reoperation Following Midurethral Sling: Analysis of 8772 Cases Using a National Prospective Database

Cited by 19 publications

References 25 publications

Prevention, diagnosis, and management of midurethral mesh sling complications

Prevention, diagnosis, and management of midurethral mesh sling complications

Transobturator midurethral sling: What should patients expect after surgery?

Midurethral sling complications

Contact Info

Product

Resources

About