The effects of "unilateral midurethral sling cut down" in women with voiding dysfunctions after anti-incontinence surgery.

Abstract

Midurethral synthetic sling (MUS) placement via either the retropubic or transobturator route is the standard surgical procedure for women with stress urinary incontinence. However, a small portion of patients experienced voiding dysfunction after the surgery, which was debilitating to their quality of life. Our study was aimed at demonstrating the effectiveness of the unilateral sling cut down for post-midurethral sling (MUS) voiding dysfunction and, secondarily, at evaluating the changes in urodynamic parameters. We retrospectively reviewed the charts of patients who received unilateral midurethral sling cut down for voiding dysfunction after an MUS procedure. The cut-down procedures were performed at the urethral meatus, in the 9 or 3 o'clock direction. Preoperative and postoperative subjective and objective parameters were compared to evaluate the outcome of the cut-down procedures. We selected 15 patients who underwent unilateral MUS cut down for voiding dysfunction after anti-incontinence procedures with various MUSs. The cut-down procedures were performed at a median interval of 7.1months after sling insertion. The subjective results of the Patient Global Impression of Improvement (PGI-I) after the cut-down procedure showed an overall satisfaction of 93.33%. After the cut-down procedure, the median flow rate increased from 14.8 to 22ml/s (P > 0.05), and the post-void residual urine volume decreased from 193.5 to 35.0ml (P < 0.05). All patients attained continence after the cut-down procedures. Unilateral MUS cut down is effective in the management of voiding dysfunction after anti-incontinence surgery, with a low risk of recurrence of urinary incontinence.