MP65-13 PROSPECTIVE EVALUATION OF THE EFFECT OF THIGH DISSECTION FOR REMOVAL OF TRANSOBTURATOR MIDURETHRAL SLINGS ON REFRACTORY THIGH PAIN

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II1 Apr 2016MP65-13 PROSPECTIVE EVALUATION OF THE EFFECT OF THIGH DISSECTION FOR REMOVAL OF TRANSOBTURATOR MIDURETHRAL SLINGS ON REFRACTORY THIGH PAIN Ashley King, Christopher Tenggardjaja, and Howard Goldman Ashley KingAshley King More articles by this author , Christopher TenggardjajaChristopher Tenggardjaja More articles by this author , and Howard GoldmanHoward Goldman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1224AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Stress urinary incontinence (SUI) can be treated successfully with both retropubic and transobturator midurethral synthetic slings. Transobturator slings were developed to decrease the risk of injury to the viscera and have been found to have lower rates of de novo irritative symptoms. However, they do have higher rates of de novo neurologic symptoms, most commonly related to the thigh. These symptoms can initially be treated conservatively; however, refractory cases may require removal of the thigh portion of the sling. The objective of our series was to prospectively examine the effect of thigh dissection with mesh removal on refractory thigh pain. METHODS All thigh dissections for refractory neurologic symptoms after transobturator sling placement were followed prospectively from 10/2012 to 10/2015. Patients were assessed thoroughly preoperatively, including obtaining a pain score using a visual analog scale, and postoperatively with a global response assessment. RESULTS A total of 11 thigh dissections were performed from 10/2012-10/2015 on 8 patients. All patients had failed conservative management. All cases were performed by a single urologist without any consulting surgeons. Average age of the patients was 53.7 (± 9.2), and the mean time from mesh placement to presentation to our clinic was 2.7 (± 1.5) years. Prior to our initial thigh dissection, 62.5% of the patients had already undergone transvaginal mesh excision. Average preoperative pain score was 7.9 (± 1.7) out of 10 with pain in the thigh in all patients. Initially, 7 cases involved unilateral thigh dissection; one patient underwent concomitant bilateral thigh dissection. Five patients underwent concurrent transvaginal excision. Average operative time was 135.8 (± 145.5) minutes; mean estimated blood loss was 77.9 (± 35) mL. On postoperative evaluation, the average global response rating was 1.6 with 1=very much better and 2=much better. Four of the eight patients went on to have the contralateral side done with average global response rating of 1.3 (±0.6). One patient underwent further treatment for SUI with placement of a TVT sling. CONCLUSIONS Our prospective series supports the use of thigh dissection in patients with refractory neurologic symptoms after transobturator sling placement. Significant relief of symptoms is possible in the small minority of patients with significant thigh pain after transobturator slings. The procedure can be performed safely with positive outcomes for the patient. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e869 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ashley King More articles by this author Christopher Tenggardjaja More articles by this author Howard Goldman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...