The Risk of Recurrent Urinary Incontinence Requiring Surgery After Suburethral Sling Removal for Mesh Complications

Ramart, Patkawat; Ackerman, A. Lenore; Cohen, Seth A.; Kim, Ja-Hong; Raz, Shlomo

doi:10.1016/j.urology.2017.01.060

Cited by 25 publications

(35 citation statements)

References 23 publications

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“…One study, with a mixed cohort of women (with initial mesh surgery for either incontinence or prolapse), found that more women had recurrent SUI and recurrent cystocele following complete mesh removal compared with partial removal, but this was not statistically significant. Another study, including women who all had initial mesh surgery for incontinence, did not find a difference in incontinence outcomes following complete mesh removal and mesh excision; 36.7% of women in this study required a second incontinence procedure . A third study in women who had originally undergone mesh for SUI reported that, compared with mesh division, mesh excision resulted in significantly more women experiencing recurrent SUI symptoms (56.1 versus 13%, respectively; P = 0.02) and having a reoperation for SUI (28.1 versus 4.4%, respectively; P = 0.002) …”

Section: Resultsmentioning

confidence: 58%

“…One study reviewed a prospectively collected database, whereas all other studies were retrospective; 17 studies were conducted in the USA, three studies were conducted in Germany, three studies were conducted in France, and one study was conducted in Taiwan . Five studies provided comparative data …”

Section: Resultsmentioning

confidence: 99%

“…Only four studies specified that women underwent initial mesh surgery for POP, and eight studies specified that the initial mesh surgery was for SUI . The remaining studies included women who had initial mesh surgery for POP and/or SUI, but did not report outcomes separately for these women.…”

Section: Resultsmentioning

confidence: 99%

“…Nineteen studies reported outcomes following mesh revision surgery, although they did not report the indication for referral. Three studies compared complete with partial mesh removal, one study compared complete removal with segment excision, and one study compared mesh division with mesh excision …”

Section: Resultsmentioning

confidence: 99%

“…In these two studies, women had all had initial mesh surgery to treat prolapse. One study, where all women initially had mesh for incontinence, showed 20.5% of women had multiple procedures for mesh revision …”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Management of mesh complications following surgery for stress urinary incontinence or pelvic organ prolapse: a systematic review

Carter

Fou

Whiter

et al. 2019

BJOG

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Background Mesh surgery for stress urinary incontinence or pelvic organ prolapse can result in complications such as mesh exposure, mesh extrusion, voiding dysfunction, dyspareunia, and pain. There is limited knowledge or guidance on the effective management for mesh‐related complications. Objective To determine the best management of mesh complications; a systematic review was conducted as part of the national clinical guideline ‘Urinary incontinence (update) and pelvic organ prolapse in women: management’. Search strategy Search strategies were developed for each indication for referral. Selection criteria Relevant interventions included complete or partial mesh removal, mesh division, and non‐surgical treatments such as vaginal estrogen. Data collection and analysis Characteristics and outcome data were extracted, and as a result of the heterogeneous nature of the data a narrative synthesis was conducted. Main results Twenty‐four studies were included; five provided comparative data and four studies stated the indication for referral. Reported outcomes (including pain, dyspareunia, satisfaction, quality of life, incontinence, mesh exposure, and recurrence) and the reported incidences of these varied widely. Conclusions The current evidence base is limited in quantity and quality and does not permit firm recommendations to be made on the most effective management for mesh‐related complications. Robust data are needed so that mesh complications can be managed effectively in the future. Tweetable abstract Systematic review demonstrates that the outcomes following mesh revision surgery are highly variable.

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Section: Resultsmentioning

confidence: 58%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Management of mesh complications following surgery for stress urinary incontinence or pelvic organ prolapse: a systematic review

Carter

Fou

Whiter

et al. 2019

BJOG

View full text Add to dashboard Cite

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Unilateral J‐cut division versus partial and subtotal removal techniques in female patients with mesh‐related urethral obstruction: Multicentric comparative study

Çetinel,

Kalender,

Kırlı

et al. 2024

BJUI Compass

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ObjectiveTo compare the functional (obstruction relieving) outcomes and complications of unilateral J‐cut division, partial and subtotal vaginal removal techniques were performed for mesh‐related urethral obstruction (MRUO) in females.MethodsPatient review included demographics, a medical history and proforma with details of lower urinary tract symptoms (LUTS), physical and urodynamic findings, detailed surgical reports and follow‐up data. Variables were compared between the three groups.ResultsOut of 130 patients with sling revision surgery (SRS), 54 women underwent SRS for MRUO with a median follow‐up of 48 (17–96) months. Unilateral J‐cut division, partial and subtotal vaginal removal techniques were performed in 12, 31 and 11 patients with a median duration of surgery of 30 (25–34), 40 (35–56) and 60 (60–70) minutes, respectively (p = 0.001). Statistically significant increase in median maximum free urine flow rate and decrease in median post‐void residual urine volume were found after SRS in the three groups, while de novo stress urinary incontinence (SUI) developed in 10%, 44% and 60% of the patients in the unilateral J‐cut division, partial and subtotal removal groups, respectively (p = 0.007).ConclusionsThe unilateral J‐cut division technique was as effective as the partial and subtotal vaginal removal techniques in relieving MRUO with a shorter duration of surgery time (p = 0.001) and lower risk of de novo SUI (p = 0.007). Comparative studies with a larger number of patients are needed.

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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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The Risk of Recurrent Urinary Incontinence Requiring Surgery After Suburethral Sling Removal for Mesh Complications

Cited by 25 publications

References 23 publications

Management of mesh complications following surgery for stress urinary incontinence or pelvic organ prolapse: a systematic review

Management of mesh complications following surgery for stress urinary incontinence or pelvic organ prolapse: a systematic review

Unilateral J‐cut division versus partial and subtotal removal techniques in female patients with mesh‐related urethral obstruction: Multicentric comparative study

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

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