Management of recurrent stress urinary incontinence and urinary retention following midurethral sling insertion in women.

H Hashim,Tr Terry

doi:10.1308/003588412x13373405385610

Abstract

INTRODUCTIONSynthetic midurethral slings are the most common operations performed for women with stress urinary incontinence (SUI). However, there is only very scarce evidence regarding the management of complications from these operations. The aim of this survey was to canvass expert opinion regarding the management of recurrent SUI and urinary retention following insertion of these slings.METHODSExpert urologists and urogynaecologists in the UK with an interest in SUI were identified. Three clinical scenarios on recurrent SUI and one on urinary retention following midurethral sling placements were emailed twice to the experts.RESULTSThe majority of the experts chose a repeat synthetic midurethral retropubic transvaginal tape (TVT) as the procedure of choice for recurrent SUI in patients who had had a previous TVT or midurethral transobturator tape inserted. In patients who continued to suffer SUI after a failed second TVT, there were mixed results with experts choosing fascial slings, colposuspension and bulking agents as their preferred method of treatment. In women who develop urinary retention following a TVT, tape pull-down within two weeks was the preferred method among the experts. However, division of the tape within two to six weeks following the procedure was also popular.CONCLUSIONSBased on expert opinion, it is difficult to make a recommendation as to the best method of treating recurrent SUI or urinary retention following tape insertion. There is an urgent requirement for well conducted, multicentre, randomised clinical trials to look at the management of these complications and also the tools used to assess the patient before salvage surgical management.

Highlights

Synthetic midurethral slings are the most common operations performed for women with stress urinary incontinence (SUI)
Twenty-one urologists and twenty-one urogynaecologists were identified in the UK who were regarded as leading experts in the field of SUI
Only 64% responded with answers to the questions (Fig 1). Those who responded to the emails but did not answer the questions replied saying they did not wish to participate in the survey or wanted further clinical information about the scenarios before being able to make a decision

Summary

Introduction

Synthetic midurethral slings are the most common operations performed for women with stress urinary incontinence (SUI). There is only very scarce evidence regarding the management of complications from these operations The aim of this survey was to canvass expert opinion regarding the management of recurrent SUI and urinary retention following insertion of these slings. Three clinical scenarios on recurrent SUI and one on urinary retention following midurethral sling placements were emailed twice to the experts. RESULTS The majority of the experts chose a repeat synthetic midurethral retropubic transvaginal tape (TVT) as the procedure of choice for recurrent SUI in patients who had had a previous TVT or midurethral transobturator tape inserted. In women who develop urinary retention following a TVT, tape pull-down within two weeks was the preferred method among the experts. CONCLUSIONS Based on expert opinion, it is difficult to make a recommendation as to the best method of treating recurrent SUI or urinary retention following tape insertion. There is an urgent requirement for well conducted, multicentre, randomised clinical trials to look at the management of these complications and the tools used to assess the patient before salvage surgical management

Methods

Results

Discussion

Conclusion