Lower urinary tract symptoms following sling revision in patients with urethral erosion from a midurethral sling

Abstract

To determine if the location and degree of urethral erosion from a midurethral sling impacts resolution of lower urinary tract symptoms (LUTS). Retrospective chart review was done on patients who underwent surgery for urethral erosion from a midurethral sling. Clinic and hospital electronic medical records were searched for pertinent pre-, intra-, and post-operative data. Urethral erosions were classified as partial (dorsal or ventral) or complete, and location along the urethral length. Descriptive statistics was utilized to categorize data. Analysis for significance (p-value < 0.05) was performed with the student’s t-test, chi-square and Fisher’s Exact tests. Eight patients had urethral erosion from a midurethral sling (Table 1 shows demographics). Average time from midurethral sling placement to revision surgery was 42 months (range 12-168). Preoperatively, most patients (75%) had more than two LUTS: urinary incontinence (87.5%), urgency (75%), frequency (50%), voiding difficulty (50%), recurrent urinary tract infections (UTI) (37.5%); 87.5% also had pelvic organ prolapse, dyspareunia, pain. Table 2 shows location of urethral erosion and symptoms. The management of urethral erosions depended on their classification and location (1-transvaginal with urethrotomy and reconstruction, 2-transvaginal and cystoscopy assisted, and 3-transurethral/cystoscopy). All foreign bodies were removed from the urethral lumen at the initial surgery in 75% of patients, 2 needed additional procedures. At a mean follow-up of 8 weeks (range 3-60), 62.5% of patients had complete symptom resolution (p<0.03), 87.5% had no urinary incontinence (p<0.01), and urinary urgency improved (p<0.04). Only 3 patients (37.5%) reported symptoms (urgency, frequency, nocturia, SUI, voiding difficulty, slow stream, recurrent UTIs- each only 12.5%). In patients with urethral erosion from a midurethral sling, most can expect significant resolution of their lower urinary tract symptoms after sling revision with removal of all luminal mesh.View Large Image Figure ViewerDownload Hi-res image Download (PPT)