Disabling complications with slings for managing female stress urinary incontinence

Abstract

OBJECTIVETo 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 METHODSThirty‐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.RESULTSThe 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.CONCLUSIONSThe 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.

The value of surgical release after obstructive anti-incontinence surgery: An aid for clinical decision making

“…Again, patients do not remain completely asymptomatic after surgical release, but their symptoms diminish and shift from obstruction to isolated OAB (+UI) and SUI (see Table ), which explains the need of multimodal treatment. These symptoms are the main reasons for patients to remain dissatisfied despite personalized therapy, which is confirmed in literature …”

“…[1][2][3][4][5][6] In our tertiary referral center, an increasing amount of patients present with voiding dysfunction after previous SUI surgery, which has been reported by others as well. 7 Because it is a relatively rare complication, diagnosis and subsequent treatment is often late. Furthermore, there is a still an active discussion on how to optimally treat this condition.…”

Mesh complications in female pelvic floor reconstructive surgery and their management: A systematic review

“…[108] Local application of estrogen cream might allow a layer of vaginal mucosa to grow and cover the sling. [114] Based on patient selection, this may be helpful in 0–100% cases [Table 14]. …”

Current Concepts in Female Neurogenic Voiding Dysfunction

“…Bladder neck pubovaginal slings (with or without bladder reconstruction) provide reasonable success rates [60]. The autologous fascial sling is most appropriate due to the increased risk of urethral erosion with an obstructing synthetic sling [61][62][63]. The synthetic bladder neck sling is no longer recommended in this population due to the high erosion rates.…”