Transvaginal tape lysis for urinary obstruction after suburethral tape placement. When to do an immediate replacement?

Abstract

To evaluate the interest and the indications of an immediate replacement of a suburethral tape after tape lysis for urinary obstruction is the aim of the study. From 2000 until 2007, a total of 22 patients underwent suburethral tape placement for stress urinary incontinence and developed thereafter a bladder outlet obstruction. These patients had a transvaginal tape lysis under local anesthesia. An immediate replacement of the tape was carried out in those patients who developed leakage under cough provocation test. Twelve patients (group 1) underwent a tape lysis and replacement. Ten patients (group 2) underwent a simple tape lysis. The two groups were demographically comparable. The continence rate was 100% in the two groups. The success rate defined by urodynamics was 75% for the first group and 80% for the second group. The success rate defined by the disappearance of the initial symptoms and improvement of the scores of the questionnaires was 75% for the first group and 90% for the second group.

European Association of Urology Guidelines on the Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 2: Underactive Bladder, Bladder Outlet Obstruction, and Nocturia

“…Urethrolysis. Case series show improved voiding and lower PVR volumes, improvement or resolution of symptoms and QoL, and improvement of urodynamic parameters after urethrolysis treatment [82][83][84]. De novo SUI was reported in 39% of cases in one study [84].…”

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

“…Overall, 23 [14][15][16][17][18][19][20][21][22][23][25][26][27][30][31][32]36,[38][39][40][41]47,48 singlegroup studies that evaluated partial mesh removal, four 3,44-46 single-group studies that looked at total mesh removal, and four comparative studies support an association between improvement in lower urinary tract symptoms after surgery, regardless of mesh removal amount.…”

“…Of the four patients with persistent bladder outlet obstruction, mesh sling transection was performed 4-8 months later with 100% resolution. Comparative and single-group studies 3,14,17,19,20,23,[26][27][28][29][30][31][32]39,41,[43][44][45]52,54 demonstrated no difference in bladder outlet obstruction outcomes between total and partial mesh excision; both techniques showed an associated improvement in bladder outlet obstruction symptoms.…”

“…Of the 35 single-group studies that report partial mesh removal surgeries, 14–41 nine assessed the outcomes of sling transection 15–17,19,20,24,28,31,32 and four studied mesh mobilization. 27,29,39,42 The five total mesh removal studies 3,43–46 looked at a combination of retropubic and transobturator slings, with the exception of Coskun, 42 who report only on mini-slings.…”