560 INCONTINENCE SYMPTOMS FOLLOWING SUBURETHRAL SLING REMOVAL

Abstract

You have accessJournal of UrologyUrodynmaics/Incontinence/Female Urology: Incontinence, Evaluation & Therapy (I)1 Apr 2013560 INCONTINENCE SYMPTOMS FOLLOWING SUBURETHRAL SLING REMOVAL Leah Nakamura, Forrest Jellison, Lisa Rogo-Gupta, Tamara Hartshorn, Denise Chow, Larissa Rodriguez, Ja-Hong Kim, and Shlomo Raz Leah NakamuraLeah Nakamura Los Angeles, CA More articles by this author , Forrest JellisonForrest Jellison Los Angeles, CA More articles by this author , Lisa Rogo-GuptaLisa Rogo-Gupta Los Angeles, CA More articles by this author , Tamara HartshornTamara Hartshorn Los Angeles, CA More articles by this author , Denise ChowDenise Chow Los Angeles, CA More articles by this author , Larissa RodriguezLarissa Rodriguez Los Angeles, CA More articles by this author , Ja-Hong KimJa-Hong Kim Los Angeles, CA More articles by this author , and Shlomo RazShlomo Raz Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1956AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There have been a growing number of cases of mesh removal surgery. We reviewed our experience looking specifically at incontinence rates and the need for subsequent surgery for incontinence after the removal of suburethral slings. METHODS A retrospective review was performed on women who underwent removal of a suburethral synthetic mesh sling between 2001 and May 2012. Incontinence was evaluated both before and after mesh removal. Data was collected from UDI-6 surveys and clinical notes. Subsequent surgery for stress urinary incontinence was also reviewed. Patients without incontinence data and those with mesh placed for prolapse repair were excluded. Multiple pre and perioperative variables were evaluated using chi square analysis. RESULTS There were 96 patients who had suburethral slings removed alone that met criteria for analysis. Pre mesh removal, only 18.9% reported being continent. Fourty-six patients (48%) had mesh exposure, 41 patients (44%) complained of pain and 23 (24.5%) had recurrent infections. Fourty-five patients (47.4%) had retropubic slings removed, 41 (43.2%) had transobturator slings, 2 had mini-slings (2.1%) and 7 (7.4%) had multiple slings removed. Fourty-five patients had only partial mesh removal while 51 patients had their entire mesh removed. Fifteen patients had either mesh or autologous fascia slings placed concurrently at the time of mesh removal. Post mesh removal, 18.8% reported no incontinence, 33.3% reported stress, 16.7% had urge, 24% had mixed, and 7.3% had continuous incontinence. Overall 49.5% of patients needed a subsequent surgery for incontinence. Amongst the patients who were continent pre-mesh removal, 66.7% developed incontinence and 44.4% needed a subsequent surgery for stress incontinence. Patients with a BMI≥25 were more likely to need a subsequent surgery (67% vs. 34.5%, P=0.013). Patients who had their mesh removed more than 3 years after it was placed were also more likely to need surgery (63.9% vs. 40.7%, P=0.047). An operative time >60 minutes was more predictive of needing a subsequent surgery for incontinence (64.3% vs. 37.3%, P=0.07). Multiple other variables had no statistically significant effect on incontinence or need for subsequent surgery. CONCLUSIONS Incontinence after mesh removal is an adverse effect that patients should be appropriately counseled about preoperatively. Almost 50% of patients need subsequent surgeries to treat their incontinence. The likelihood of needing repeat anti-incontinence surgery is related to overall BMI, time interval between the original surgery and mesh sling removal, and operative time. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e230 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leah Nakamura Los Angeles, CA More articles by this author Forrest Jellison Los Angeles, CA More articles by this author Lisa Rogo-Gupta Los Angeles, CA More articles by this author Tamara Hartshorn Los Angeles, CA More articles by this author Denise Chow Los Angeles, CA More articles by this author Larissa Rodriguez Los Angeles, CA More articles by this author Ja-Hong Kim Los Angeles, CA More articles by this author Shlomo Raz Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...