Unilateral sling transection for patients with postoperative voiding dysfunction after transobturator sling surgery

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

“…Two studies compared different types or timing of partial sling removal: One article 14 evaluated the difference between sling mobilization and transection, and another 15 looked at early mesh transection (less than 1 year since the index surgery) compared with late transection (more than 1 year since the index surgery). Of the 35 single-group studies that report partial mesh removal surgeries, nine assessed the outcomes of sling transection [15][16][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 minislings.…”

“…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.…”

Translabial Ultrasound

“…7 Voiding dysfunction, including bladder outflow obstruction, has been reported to affect up to 15% of patients after MUS surgery. 8,9 Surgical MUS "transection," which is also described as sling "lysis" or "release," involves a single vertical incision into the sling's midline and is the standard method to manage persistent voiding dysfunction that results from an obstructive sling. [10][11][12] In addition to midline transection of the mesh, a small excision of a midline segment of mesh of a few millimeters in length may also be performed based on surgeon discretion to achieve adequate release, which is known as a partial MUS "excision" or "removal."…”

“…Within 10 years of sling placement, about 1 in 20 women undergo subsequent surgery to revise their mesh 7 . Voiding dysfunction, including bladder outflow obstruction, has been reported to affect up to 15% of patients after MUS surgery 8,9 . Surgical MUS “transection,” which is also described as sling “lysis” or “release,” involves a single vertical incision into the sling's midline and is the standard method to manage persistent voiding dysfunction that results from an obstructive sling 10–12 .…”