Evaluation and Management of Mid-Urethral Sling Complications

Abstract

Currently, a mid-urethral sling is the standard of care for the treatment of female stress urinary incontinence. However, complications can occur that are unique to polypropylene mesh such as mesh exposure, perforation, or contracture. Other complications such as de novo urgency and/or urgency urinary incontinence (UUI), urinary tract infection, and/or urinary obstruction can also occur. The diagnosis of these complications requires a high index of suspicion, and treatment is critical as these complications can be quite morbid. As such, this review will discuss the most recent literature regarding the intraoperative and post-operative evaluation and management of mid-urethral sling complications.

Randomized controlled trial comparing single‐incision mini‐sling and transobturator midurethral sling for the treatment of stress urinary incontinence: 3‐year follow‐up results

“…In relation to complications, the rates of tape exposure (4.9% in each group) and lower urinary tract symptoms including de novo urgency (12.2% in SIMS and 4.9% in TOT groups) were in accordance to the other reports . A nonsignificant trend towards higher rates of repeat continence surgery was noted in the SIMS group compared to TOT (10.1% and 3.3%, respectively).…”

“…26,30 In relation to complications, the rates of tape exposure (4.9% in each group) and lower urinary tract symptoms including de novo urgency (12.2% in SIMS and 4.9% in TOT groups) were in accordance to the other reports. [31][32][33][34] A nonsignificant trend towards higher rates of repeat continence surgery was noted in the SIMS group compared to TOT (10.1% and 3.3%, respectively). Despite not being statistically significant, our findings may be clinically relevant as the reoperation rate is an important metric for surgeons caring for women with SUI.…”

Recurrent Incontinence After Transvaginal Partial Sling Excision in Patients with Prior Mid-Urethral Sling

“…3,4 While conventional thinking has been to treat these complications conservatively, it has been shown that treatment such as medications, behavioral therapy, and physical therapy frequently do not result in improvement of the patient's symptoms. 5 Various surgical options exist for treatment including sling explant, which has been considered the procedure of choice to address symptoms refractory to medical treatment. 6 This procedure involves removing the vaginal portion as well as the lateral arms that extend into either the obturator/adductor muscles or retropubic space of which either can be associated with substantial morbidity.…”