Salvage Surgery after Failed Treatment of Synthetic Mesh Sling Complications

Blaivas, Jerry G.; Purohit, Rajveer S.; Weinberger, James; Tsui, Johnson F.; Chouhan, Jyoti D.; Sidhu, Ruhee; Saleem, Kamron

doi:10.1016/j.juro.2013.03.044

Cited by 29 publications

(43 citation statements)

References 22 publications

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“…Blaivas et al reported a retrospective review of 47 women who had previously undergone at least 1 operation to correct MUS complications [64]. With a mean follow-up of 3 years, 72 % of patients had a successful outcome after the first procedure.…”

Section: Long-term Sequelaementioning

confidence: 99%

Evaluation and Management of Mid-Urethral Sling Complications

Brown

Cohn

Kaufman

et al. 2016

Curr Bladder Dysfunct Rep

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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.

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Section: Long-term Sequelaementioning

confidence: 99%

Evaluation and Management of Mid-Urethral Sling Complications

Brown

Cohn

Kaufman

et al. 2016

Curr Bladder Dysfunct Rep

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“…The effects of long-term pain receive no attention at all in any study except for a few case studies of complications. 9,[40][41][42][43][44] The concomitant, widespread use of two different generic sling designs (RP and TOT) with different implantation techniques and at least 41 different commercially available kits, 42 each having different sling and trocar characteristics with potentially different complication profiles, confounds accurate analysis of sling complications. These different characteristics might also portend different complication profiles, yet studies of sling complications almost never distinguish between the different kit types and many do not even separate TOT from RP slings.…”

Section: Smus Complicationsmentioning

confidence: 99%

“…6 Furthermore, this study 6 excluded patients whose slings were removed owing to pain and other indications, thus the actual incidence of sling removal owing to complications is probably even higher than that. Extrapolating from this estimate and the estimated number of slings implanted in the 6,9,10,41,44,[100][101][102][103][104][105][106][107][108][109][110][111][112][113][114] Use of imperfect research methodologies, a lack of long-term follow up and reporting bias have been suggested as causes of these differences. 10,45,115,116 Safety and risk:benefit considerations Safety of SMUS surgery refers to the probability of any adverse event, while risk describes the range and probability of specific adverse events.…”

Section: Smus Complicationsmentioning

confidence: 99%

“…As more SMUS implantations are being performed and the longevity expectations of patients with SMUS are increasing, it has become apparent that unanticipated, serious, sometimes lifestylealtering complications can occur that are not only unique to patients with SMUS but are also often refractory to treatment. 9,10 The purpose of this Review is to summarize the published literature regarding complications that are uniquely associated with SMUS and to present an o verview of complications that are not unique to these slings.…”

Section: Introductionmentioning

confidence: 99%

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Safety considerations for synthetic sling surgery

et al. 2015

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Implantation of a synthetic midurethral sling (SMUS) is the most commonly performed anti-incontinence operation in women worldwide. The effectiveness of the SMUS is comparable to that of the historical gold standards--autologous fascial slings and the Burch colposuspension. Much controversy, however, has evolved regarding the safety of this type of sling. Overall, the quality of the studies with respect to assessing risks of SMUS-associated complications is currently poor. The most common risks in patients with SMUS include urethral obstruction requiring surgery (2.3% of patients with SMUS), vaginal, bladder and/or urethral erosion requiring surgery (1.8%) and refractory chronic pain (4.1%); these data likely represent the minimum risks. In addition, the failure rate of SMUS implantation surgery is probably at least 5% in patients with stress urinary incontinence (SUI). Furthermore, at least one-third of patients undergoing sling excision surgery develop recurrent SUI. Considering the additional risks of refractory overactive bladder, fistulas and bowel perforations, among others, the overall risk of a negative outcome after SMUS implantation surgery is ≥15%.

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“…Unfortunately the results of mesh removal in such individuals are mixed at best. 7,8 Indeed, Milose et al note sobering results for those individuals presenting with SUI with complex coexisting factors such as fistula or urethral erosion, of which only 3 of 8 had SUI cured with fascial sling. 6 Nevertheless, such redo cases add another layer of complexity and another category of deficiencies in individuals with SUI.…”

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confidence: 99%