Surgical Removal of Midurethral Sling in Women Undergoing Surgery for Presumed Mesh-Related Complications

Doyle, Paula; Grimes, Cara L.; Balk, Ethan M; Wieslander, Cecilia; Richardson, Monica L.; Mamik, Mamta M.; Sleemi, Ambereen; Alas, Alexandriah; Kudish, Bela; Walter, Andrew J.; Aschkenazi, Sarit; Mama, Saifuddin T.; Foda, Mohamed A.; Meriwether, Kate V.

doi:10.1097/aog.0000000000004646

Cited by 5 publications

(11 citation statements)

References 51 publications

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“…However, it is lower when compared with other series of complete removal, in which up to 69% have been reported 19,21 . Indeed, a recent systematic review concluded that the risk of post‐operative SUI is lower after partial mesh removal compared to total (odds ratio 0.46, 95% CI 0.22–0.96) 22 . This must be balanced with the potential risk of the initial symptom persistence in case of partial removal.…”

Section: Discussionmentioning

confidence: 92%

“… 19 , 21 Indeed, a recent systematic review concluded that the risk of post‐operative SUI is lower after partial mesh removal compared to total (odds ratio 0.46, 95% CI 0.22–0.96). 22 This must be balanced with the potential risk of the initial symptom persistence in case of partial removal. Post‐operative bothersome urgency was reported in 37% of the patients, which differs significantly from a series that reported an increase in urgency after total mesh removal in 80%.…”

Section: Discussionmentioning

confidence: 99%

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Quality of life outcomes after transobturator tape full removal surgeries: A monocentric experience

Perrouin‐Verbe,

Ochoa,

Skews

et al. 2024

BJUI Compass

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ObjectiveThe objective of this study is to describe a standardised technique of full TOT removal with groin dissection and to report clinical improvement, satisfaction, safety and long‐term functional, quality of life (QoL) and sexual QoL outcomes.Materials and methodsA retrospective review enrolling all women who had full TOT removal, in a tertiary referral centre from May 2017 to November 2020. Functional outcomes, satisfaction and QoL were assessed using a bespoke composite questionnaire (UDI‐6, EQ‐5D‐5L and ICIQ‐S) with additional questions on sexual QoL. Secondary outcomes were post‐operative recurrent stress urinary incontinence (SUI) and complication rate according to the Clavien‐Dindo classification.ResultsFull TOT removal using a vaginal approach and bilateral groin/para‐labial incisions was performed in 67 patients. Chronic pelvic pain was the main indication for mesh removal (51% of cases, n = 34). QoL questionnaires were answered by 43 patients. The satisfaction rate was high 86% (n = 37), and 81% (n = 35) of the patients considered the surgery successful. Seventy per cent (n = 30) of patients returned to having a sexual life after surgery. Recurrent SUI was reported in 32% (n = 14) of cases. The complication rate was 10% (7/67), all of them Clavien–Dindo ≤2.ConclusionDespite a high rate of postoperative bothersome SUI, full TOT removal with bilateral groin dissection improves pain and QoL. It is associated with a high overall satisfaction rate and an acceptable rate of complications.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Quality of life outcomes after transobturator tape full removal surgeries: A monocentric experience

Perrouin‐Verbe,

Ochoa,

Skews

et al. 2024

BJUI Compass

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“…This makes sense, as the endoscopic procedure, in this case, breaks the continuity of the sling, and therefore these women would be expected to have a higher risk of incontinence (one of the components of the UDI‐6 score). A recent systematic review identified a higher risk of stress incontinence after complete sling removal compared to partial transvaginal removal, 17 therefore it is reasonable that endoscopic resection (representing the smallest possible partial removal) would minimize this risk for women. Fourth, most of the previous reports of endoscopic management of urinary mesh extrusion have focused on mesh within the bladder, and a small series suggested that treatment of intraurethral mesh extrusion may not have satisfactory results compared to intravesical mesh extrusion (33% vs. 80% anatomic success respectively) 18 .…”

Section: Discussionmentioning

confidence: 99%

Endoscopic management of intraurethral mesh extrusion with the holmium:YAG laser is an acceptable treatment option in selected patients

Allagany

Dekalo

Welk

2022

Neurourology and Urodynamics

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Introduction: Extrusion of transvaginal mesh into the urethra is a rare but potentially serious complication. Our objective is to evaluate the efficacy and long-term outcomes of women who underwent an endoscopic laser procedure to treat intraurethral mesh. Materials and Methods:A retrospective chart review identified women who underwent an endoscopic Holmium:YAG laser procedure to treat intraurethral mesh between September 2011-October 2021. Information about the procedure, symptoms, and level of incontinence was gathered from the medical records. Primary outcomes were the need for further procedures, and the Urinary Distress Index-6 score at last follow-up. Results: We identified a total of 29 women; mesh sling procedure included tension-free vaginal sling (19), transobturator sling (6), or other transvaginal mesh sling (4). Presentation of intraurethral mesh was a median of 6 (interquartile range [IQR]: 1-7) years after placement. After the endoscopic procedure, 18/29 (62%) women had no visible urinary mesh and complete resolution of their presenting symptoms. Retreatment was necessary in 3/29 women, and 6/29 (21%) reported new or worsening stress incontinence. The UDI-6 was completed by all patients at a median of 3.7 (IQR: 2.0-5.8) years after their endoscopic procedure. The median score was 22 (IQR: 11-44), and 18/29 (62%) women had scores in the asymptomatic range. UDI-6 scores were similar for the six women who had further mesh procedures and the ones who did not. Conclusions: Endoscopic laser treatment of an eroded transvaginal mesh sling is an acceptable treatment with minimal morbidity and satisfactory UDI-6 scores after a median follow-up of 3.7 years.

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“…163 A recent systematic review found no difference between partial or total mesh removal regarding improvement in pain outcomes, with a postoperative risk of recurrent SUI lower with partial vs. total mesh removal. 165,166…”

Section: How Should Pain After Transvaginal Mus Be Investigated and M...mentioning

confidence: 99%

“…176,177 Transvaginal mesh removal and urethral repair is an alternative treatment approach that is likely associated with more potential morbidity and a higher risk of post-procedure stress incontinence. 165,178 To lessen morbidity, a staged primary endoscopic excision/release may be considered prior to open transvaginal excision. In most cases, management of this complication should be referred to an appropriate specialist with experience managing transvaginal mesh complications.…”

Section: What Is the Risk Of Mesh Exposure In The Urinary Tract After...mentioning

confidence: 99%

2024 Canadian Urological Association guideline: Female stress urinary incontinence

Carlson,

Andrews,

Bascom

et al. 2024

CUAJ

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prior to publication, this guideline underwent review by the cua guidelines steering committee and expert reviewers. INTRODUCTION & PURPOSEFemale stress urinary incontinence (FSUI) is a common condition that affects approximately 10-20% of the population. 1 It is associated with negative impacts on quality of life (QoL), socialization, and exercise; it has a significant financial impact, and is associated with depression and anxiety. 2 In 2012, the last Canadian Urological Association (CUA) guideline addressing adult urinary incontinence was published; it covered male and female nonneurogenic stress and urgency incontinence. 3 Given the considerable changes in the management of FSUI, and the very distinct considerations and surgical procedures for this group, an individual guideline providing a more detailed overview of this topic was requested by the CUA Guidelines Steering Committee.The specific population this guideline is intended to cover is women over 18 years of age with stress urinary incontinence. This CUA guideline is intended to be used by healthcare providers treating patients with FSUI. The guideline objective is to cover topics important to the evaluation, counselling, non-surgical and surgical treatment of FSUI, and the management of complications of FSUI surgery.Given the significant variation in patients with FSUI, in some sections we focus on the evaluation and management of the "index patient" (similar to other guidelines). 4,5 Other sections are dedicated to specific nonindex patients with FSUI. We recognize that guidelines cannot address the management of all FSUI scenarios. METHODOLOGYWe decided to use a question-and-answer format to provide brief, accessible, and practical answers to common questions addressing the evaluation and management of FSUI. The guideline panel was created to provide representation from a mix of community and academic urologists and allied health professionals from across Canada, in keeping with the CUA guideline rules. Disagreements during the guideline process were resolved by consensus-building. Conflicts of interests for the authors are included at the end of the guideline. The views or interests of the CUA did not influence the final set of recommendations.The guideline panel was led by Dr. Kevin Carlson and Dr. Blayne Welk. The group first met virtually in December 2021. Objectives to guide the development of this document were agreed upon: 1) to be comprehensive without replicating existing evidence reviews; 2) to provide evidence-based and expert-based opinions on relevant topics within FSUI; and 3) to address the unique needs of Canadian urologists where appropriate.All guideline members were asked to submit relevant topics that could be addressed in a questionand-answer format, and the final list of questions was agreed upon by the panel. Further feedback was received from CUA members at the 2022 CUA annual meeting. Individual sections were assigned to members, with another panel member acting as primary reviewer. Members reviewed publications relevant to ...

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Surgical Removal of Midurethral Sling in Women Undergoing Surgery for Presumed Mesh-Related Complications

Cited by 5 publications

References 51 publications

Quality of life outcomes after transobturator tape full removal surgeries: A monocentric experience

Quality of life outcomes after transobturator tape full removal surgeries: A monocentric experience

Endoscopic management of intraurethral mesh extrusion with the holmium:YAG laser is an acceptable treatment option in selected patients

2024 Canadian Urological Association guideline: Female stress urinary incontinence

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