Management of the Exposed or Perforated Midurethral Sling

Giusto, Laura; Zahner, Patricia; Goldman, Howard B.

doi:10.1016/j.ucl.2018.08.003

Cited by 9 publications

(12 citation statements)

References 32 publications

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“…Sling exposure/extrusion or perforation into the urinary tract, including the urethra or bladder, may cause recurrent UTIs, stone formation, or irritable LUTS (LOE 3, grade 1C) 105 …”

Section: Resultsmentioning

confidence: 99%

“…105 During MUS surgery, the patient's position, hydro-dissection, and methodical cystoscopic inspection may be helpful in preventing and identifying sling exposure/extrusion and perforation (LOE 5, grade 2D). 105 For the early detection of any sling exposure/extrusion and perforation, patients should be examined at each visit on a regular long-term basis. If any LUTS develop after the MUS procedure, a pelvic examination, including urinalysis and PVR determination, urodynamic studies, and urethrocystoscopy, may be necessary (GP, grade 1D).…”

Section: Sling Exposure/extrusion or Organ Perforationmentioning

confidence: 99%

“…Total sling excision is not commonly required, except in cases of severe debilitating pain along the sling tract (LOE 3, grade 1C). 105,110,111 Although partial sling excision may have the highest rates of complete resolution, repeat surgery may be needed if symptoms recur (LOE 4, grade 1C). 95,112 Total sling excision may be considered if there is dyspareunia, debilitating vaginal or pelvic pain, large areas of mesh exposure, other severe symptoms, local tissue infection, and involvement of the urinary tract or other organs.…”

Section: Sling Exposure/extrusion or Organ Perforationmentioning

confidence: 99%

“…Sling exposure/extrusion or perforation into the urinary tract, including the urethra or bladder, may cause recurrent UTIs, stone formation, or irritable LUTS (LOE 3, grade 1C). 105 Two-and three-dimensional ultrasound of the pelvic floor, including transperineal or intravaginal scanning, can be used to visualize sling location, proximity to the urethral and bladder lumen, anatomical causes of mesh-related pain, or any structural changes that can be correlated with clinical findings (LOE 3, grade 1B). 104,106,107 The size of the exposure/extrusion can be an important factor when considering whether to treat it conservatively (if <0.5 cm) or surgically (if >4 cm) (LOE 3, grade 1C).…”

Section: Sling Exposure/extrusion or Organ Perforationmentioning

confidence: 99%

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FIGO recommendations: Use of midurethral slings for the treatment of stress urinary incontinence

Lau

Davila

Chen

et al. 2023

Intl J Gynecology & Obste

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Background: Stress urinary incontinence (SUI) is a global problem. It can significantly adversely impact a woman's quality of life. The use of synthetic mesh in vaginal surgery is controversial, especially when used for pelvic organ prolapse surgery. Although negative effects have been reported, the synthetic mesh midurethral sling (MUS) is considered to be safe and effective in the surgical treatment of SUI.Objectives: To provide evidence-based data and recommendations for the obstetrician/gynecologist who treats women with SUI and performs or plans to perform MUS procedures. Methods: Academic searches of MEDLINE, the Cochrane Library, Embase, and Google Scholar articles published between 1987 and March 2020 were performed by a subgroup of the Urogynecology and Pelvic Floor Committee, International Federation of Gynecology and Obstetrics (FIGO).Selection Criteria: The obtained scientific data were associated with a level of evidence according to the Oxford University Centre for Evidence-Based Medicine and GRADE Working Group system. In the absence of concrete scientific evidence, the recommendations were made via professional consensus. Results:The FIGO Urogynecology and Pelvic Floor Committee reviewed the literature and prepared this evidence-based recommendations document for the use of MUS for women with SUI.Conclusions: Despite the extensive literature, there is a lack of consensus in the optimal surgical treatment of SUI. These recommendations provide a direction for surgeons to make appropriate decisions regarding management of SUI. The MUS is considered safe and effective in the treatment of SUI, based on many high-quality scientific publications and professional society recommendations. Comprehensive long-term data and systemic reviews are still needed, and these data will become increasingly important as women live longer. These recommendations will be continuously updated through future literature reviews.

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“…Sling exposure/extrusion or perforation into the urinary tract, including the urethra or bladder, may cause recurrent UTIs, stone formation, or irritable LUTS (LOE 3, grade 1C) 105 …”

Section: Resultsmentioning

confidence: 99%

Section: Sling Exposure/extrusion or Organ Perforationmentioning

confidence: 99%

Section: Sling Exposure/extrusion or Organ Perforationmentioning

confidence: 99%

Section: Sling Exposure/extrusion or Organ Perforationmentioning

confidence: 99%

See 2 more Smart Citations

FIGO recommendations: Use of midurethral slings for the treatment of stress urinary incontinence

Lau

Davila

Chen

et al. 2023

Intl J Gynecology & Obste

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“…Nevertheless, Cochrane review with high-level evidence supports that A c c e p t e d A r t i c l e MUS using type I polypropylene mesh still demonstrate long-term effectiveness and tolerable adverse events [5]. The reasons for the recent increase in mesh-related complications are: First, the incidence of complications increased due to an increase in synthetic mesh utilization [67]. Second, the problem of mesh material itself can be considered.…”

Section: Mesh Complicationsmentioning

confidence: 99%

Second-Line Surgical Management After Midurethral Sling Failure

Kwon

Kim

2021

Int Neurourol J

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Currently, midurethral sling is widely used as a standard treatment in stress urinary incontinence (SUI) patients. According to several studies, the failure rate of midurethral sling (MUS) has been reported to be approximately 5-20%. In general, the sling failure can be defined as the state that SUI persists even after the surgery or that incontinence is improved temporarily and then recurs. Additionally, it can be widely regarded as a failure that the cases requiring secondary surgery due to mesh exposure, postoperative voiding difficulty, de novo urgency/urge incontinence, and severe postoperative pain, etc.Because of the lack of a large-scale study with high quality, there has been no clear guideline for second-line management yet. To date, transurethral bulking agent injection, tape shortening, repeat MUS, pubovaginal sling (PVS) using autologous fascia, and Burch colposuspension are available options for second-line surgery. Repeat MUS is the most widely used method as a second-line surgery at present. Bulking agent injection has lower durability and efficacy compared to other treatments. Tape shortening demonstrates a relatively lower success rate but comparable outcome if the period from first treatment to relapse is short. In patients with intrinsic sphincter deficiency (ISD), PVS and retropubic (RP) MUS can be considered first as second-line management because of higher success rate compared to other treatments. When revision or reoperation is required due to prior meshrelated complications, PVS or colposuspension, which is performed without a synthetic mesh, is appropriate for the second-line surgery. For the patient with detrusor underactivity, the readjustable sling can be a better option because of the high risk of postoperative voiding dysfunction in PVS or RP sling.

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