59 In office early release of a midurethral pubovaginal sling

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In this video, we are going to demonstrate the early release of a mid urethral pubo-vaginal sling (Single Incision Sling). The patient had the sling placed nine days ago in combination with a posterior repair. Since then, she has had obstructive voiding with intermittent flow, hesitancy, and slowing of the stream. She was placed on intermittent self-catheterization with persistent, non-resolving high post void residual volumes. Because of these symptoms, we are going to perform an in office early release of the single incision sling. We are going to infiltrate with local anesthetic at the Obturator site/the superior medial notch where we know the adjustable anchor of the single incision sling is located. We will also infiltrate with local anesthetic to create hydro-dissection away from the sling so that it will be easier to move. We will then perform a diagnostic cystoscopy with retrograde filling of the bladder to 250 to 300 cc of fluid. After which, we will then perform a reverse cough test where the patient will cough and then we will move the sling millimeter at a time until the cystoscopy fluid is at the urethral meatus upon valsalva or cough. Studies show that mid urethral single incision slings are safe and effective procedures for female stress urinary incontinence with minimal postoperative complications rarely requiring early release or revision. Studies have also shown that post revision stress urinary incontinence with early release was less when compared to revision greater than two weeks. Therefore, this procedure, in office early release, should be a viable option for physicians offering mid urethral pubo-vaginal slings.