PD33-10 OUTCOMES AND PREDICTORS OF REOPERATION AFTER SLING RELEASE SURGERY

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology I1 Apr 2014PD33-10 OUTCOMES AND PREDICTORS OF REOPERATION AFTER SLING RELEASE SURGERY Marisa Clifton, Sherif A. El Nashar, Deborah Lightner, and Daniel Elliott Marisa CliftonMarisa Clifton More articles by this author , Sherif A. El NasharSherif A. El Nashar More articles by this author , Deborah LightnerDeborah Lightner More articles by this author , and Daniel ElliottDaniel Elliott More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2293AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lower urinary tract symptoms are well-documented complications of sling placement and can occur in 5-20% of patients. Urethrolysis is a common procedure utilized to relieve these symptoms. We aimed to report on the outcomes after sling release surgery and to evaluate the predictors of reoperation. METHODS A retrospective review of 143 consecutive female urethrolysis procedures at the Mayo Clinic from January 1, 2000 through August 1, 2012 was performed. Only patients who underwent primary sling placement prior to urethrolysis were included. The clinical features and outcomes of this cohort were recorded. Survival analysis and regression modeling were utilized to calculate the cumulative reoperation rate and detect potential predictors of reoperation after sling release surgery. RESULTS During our study duration, 93 women had sling release after sling placement. Eight had initial transobturator slings, 47 had autologous or cadaveric pubovaginal slings (A/C-PVS) and 38 had synthetic retropubic slings. Indications for sling release included de novo urge in 13(14%), obstruction in 76 (82%) and infections in 4 (4%). The mean age (SD) of patients at the time of sling release was 58.1 (13.2) years with a mean followup after sling release of 39.3 (range, 1 to 124) months. During followup, 22 (24%) women required an additional surgery for persistent or de novo symptoms with a 5 year cumulative reoperation rate of 26.3 % (95%CI 15.8, 36.9). Reoperation for recurrent stress urinary incontinence occurred in 13 (14%) patients and included A/C-PVS in 7, synthetic sling in 2, and bladder neck bulking injection in 4. Reoperation for persistent obstructive symptoms occurred in 9 (10%) patients and included repeat sling release in 3, InterStim placement in 2, Botox injection in 2, and urethral dilation in 2 patients. At last follow up, 28 (32%) patients were taking anticholinergic medication and 18 (21%) required continued intermittent catheterization. In the 76 women who had sling release for obstructive symptoms, those with excision or complete removal tended to have lower reoperation rates (6 /35 or 17%) compared to those who had sling incision (10/41 or 24%)(P=0.44). CONCLUSIONS One in four women who had sling release surgery required an additional operative procedure within 5 years. Patients who had sling incision for obstructive symptoms tended to require reoperation more frequently than those who had excision or complete removal of their sling. This information is invaluable during patient counselling prior to proceeding to sling release surgery. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e844 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Marisa Clifton More articles by this author Sherif A. El Nashar More articles by this author Deborah Lightner More articles by this author Daniel Elliott More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...