Functional outcomes following surgical management of pain, exposure or extrusion following a suburethral tape insertion for urinary stress incontinence

Abstract

Excision is an effective treatment for tape exposure and pain whether infection is present or not. Tapes of a multifilament type are strongly associated with infection. When infection is present, complete sling removal is necessary. A concomitant procedure to prevent recurrent SUI should be considered if tape excision is planned and infection is not suspected.

Meshology: a fast-growing field involving mesh and/or tape removal procedures and their outcomes

“…They reported a higher rate of pain in the TOT group (12%) than in the TVT group (1.3%) with an OR of 9.34 [64]. In this review, the estimated success rate based on current literature for treating pelvic pain with MUS removal varied from 95 to 100% [41][42][43][44][45]. In contrast to the management of voiding dysfunction where optimal outcomes could be achieved with MUS incision, MUS excision is preferred for the treatment of painrelated complications.…”

“…Interestingly, one in five women in their study with complications presented more than 5 years after initial MUS insertion, emphasizing the need for long-term vigilance. One-third of their patients required additional antiincontinence procedures for recurrent SUI [42]. Groin pain is a recognized complication of trocar-based system, which has been reported in up to 4% after TOT placement.…”

“…Short case series have addressed the management of women with specific symptoms after MUS placement such as chronic pelvic pain, voiding dysfunction, dyspareunia/sexual dysfunction, urogenital fistulas and vaginal mesh extrusion or erosion into the lower urinary tract [32,33,39,40]. TABLE 1 summarizes the majority of published literature with functional outcomes relating to MUS removal or lysis [41][42][43][44][45][46][47][48][49][50][51][52][53][54]. Although most of the series are from tertiary referral centers, the pervading message is that the rate of these removal procedures is on the rise.…”

Mid‐urethral sling revision for mesh exposure–long‐term outcomes of two surgical techniques from a comparative clinical retrospective cohort study

“…The risk of sling exposure was significantly lower in the RP slings than in the transobturator sling ( P = 0.03). Revisions performed predominantly for pain or voiding difficulty were excluded and have been addressed in an earlier report from our unit . The selection of patients for this analysis is outlined in Figure .…”

“…The suburethral portion of the sling can be excised to ensure that the sling exposure does not recur. Coexistent inflammation and infection around the area of exposure can prevent healing of the local tissues, resulting in unsuccessful closure when the sling is conserved . There are few studies in the literature around this important clinical question to guide doctors and their patients on the management of this complication.…”