Complications Of Midurethral Slings Research Articles

Sonography as a Diagnostic Tool in Midurethral Sling Complications: A Narrative Review.

Despite the established safety and efficacy of midurethral slings (MUS), which are the current gold standard treatment for stress urinary incontinence (SUI), the potential for postoperative complications remains a significant concern for both healthcare professionals and patients. Meanwhile, sonography has emerged as a significant diagnostic tool in urogynecology, and one of the applications of this imaging modality may be the evaluation of complications arising from MUS procedures. This review, based on a comprehensive literature search, focuses on the use of pelvic floor ultrasound (US) in the context of MUS complications. It includes analyses of randomized controlled trials, prospective, and retrospective studies, covering preoperative and postoperative investigations, to assess complications such as persistent and recurrent SUI, urinary retention and obstructive voiding, de novo urgency/overactive bladder, vaginal exposure, sling erosion, pain, and hematoma. The review critically examines the existing literature, with a particular focus on recent publications. Despite the variability in findings, it appears that for each of the discussed complications, the application of pelvic floor US can significantly support the diagnostic and therapeutic process. The paper also identifies potential future directions for the development of US applications in diagnosing MUS complications.

LONG-TERM EFFECTIVENESS AND COMPLICATIONS OF MID-URETHRAL SLINGS: CLINICAL CASE

Approximately 50% of all women suffer from urinary incontinence at least once in their lifetime. A majority of these women experience a type of urinary incontinence that is called stress urinary incontinence. Women of all ages are susceptible to this disease, however, it mostly affects older and overweight women. Even though this is not a life-threatening disease, it is important to find the most effective treatment methods to lessen the so­cial and psychological damage that is associated with this disease. Stress urinary incontinence is treated con­servatively, however, if the treatment is not successful, surgical options can be utilized. In the last few decades, surgical methods for stress urinary incontinence have changed dramatically. Burch colposuspension has long been a gold standard for surgical stress urinary inconti­nence treatment, however, its popularity has started to drop. Instead, mid-urethral slings have become the more mainstream option. Mid-urethral sling operations are not only less invasive and cause fewer complications, but are also more effective at treating stress urinary incontinence. Aim: To analyse the newest publications that review the long-term effectiveness and complications of mid-urethral slings and to also present a clinical case. Methods: A scientific literature review was conducted utilizing the following databases: Pubmed, ScienceDi­rect, UpToDate. Keywords for the search were urinary stress incontinence, Burch colposuspension, mid-urethral sling, tension-free vaginal tape. The most relevant scien­tific articles and scientific publications on the topic were selected. This article presents a generalized analysis of the scientific literature on the topic “Long-term effecti­veness and complications of mid-urethral slings: clinical case and literature review”. Results: Mid-urethral sling operations are an effective tre­atment option for stress urinary incontinence in women. Mid-urethral sling operations have lower complication risk than popular alternatives. According to the literature analysed in the study, there is no significant difference in effectiveness and complication rates between retropubic and transobturator mid-urethral slings. However, these are both quite not old treatments methods and so far there is not enough data to make a definitive conclusion.

The subjective and objective very long-term outcomes of TVT in the COVID era: A 20-year follow-up

Introduction and hypothesisFew studies in literature have assessed the long-term durability and mesh-related complications of mid-urethral slings (MUSs). The aim of this study is to assess the efficacy and safety of retro-pubic tension-free vaginal tape (TVT) 20 years after implantation for the treatment of female stress urinary incontinence (SUI).MethodsA prospective observational study was conducted in two urogynaecologic units in two countries. All the patients involved were consecutive women with urodynamically proven pure SUI treated by TVT. The patients underwent preoperative clinical and urodynamic evaluations. Subjective outcomes, objective outcomes and adverse events were recorded during the follow-up period.ResultsFifty-two patients underwent a TVT surgical procedure. Twenty years after surgery, 32 out of 36 patients (88.8%) declared themselves cured (p = 0.98). Similarly, 33 out of these 36 patients (91.7%) were objectively cured (p = 0.98). No significant deterioration of subjective and objective cure rates was observed over time (p for trend 0.50 and 0.48). Fifteen of the 36 patients (41.6%) at the 20-year follow-up reported the onset of de novo overactive bladder (OAB) (p = 0.004). No significant vaginal bladder or urethral erosion or de novo dyspareunia was recorded and no patient required tape release or resection during this period. The cause of death of seven out of ten women who died in the last year of the follow-up period was coronavirus disease 19 (COVID 19).ConclusionsThe 20-year results of this study showed that TVT is a highly effective and safe option for the treatment of SUI. The impact of COVID 19 on the mortality rate of elderly women has drastically reduced the number of eligible patients for future evaluations in our region.

Complications of mid-urethral sling - A review from the Committee for Female Urology and Pelviperineology for the French Association of Urology

Placement of a mid-urethral sling is the gold standard in the surgical management of stress urinary incontinence in women in France. The cure rate of this material is no longer to be demonstrated, but the per- and post-operative complications are currently the subject of a growing controversy not only in Europe but also across the Channel and across the Atlantic, having led to the modification of operative indications. In France, recommendations are also evolving with a stricter framework for indications for surgery by multidisciplinary consultation meeting and an obligation for postoperative follow-up in the short and long term. In this context, CUROPF realized a review of the literature bringing together the available scientific evidence concerning the occurrence of per- and post-operative complications relating to the installation of mid urethral sling. The bibliographic search was carried out using the Medline database and 123 articles were selected. Analysis of the data highlights various complications, depending on the implanted material, the patient and the indication for surgery. The retro-pubic mid urethral sling provides more bladder erosion during surgery (up to 14%), more suprapubic pain (up to 4%) and more acute urinary retention (up to 19,7%) and postoperative dysuria (up to 26%). The trans obturator mid-urethral sling is responsible for more vaginal erosion during the operation (up to 10,9%), more lower limb pain of neurological origin (up to 26,7%). The risk of developing over active bladder is similar in both procedures (up to 33%). But these risks of complications must be balanced by the strong impact of urinary incontinence surgery on the overall quality of life of these women. Thus, surgical failure and long term complications exist but should not limit the surgical management of stress urinary incontinence with mid urethral tape. Women should be treated with individualized decision-making process and long-term follow -up is necessary.

Translabial Ultrasound for Assessment of Synthetic Midurethral Sling Complications.

Translabial ultrasound (TLUS) is an inexpensive, noninvasive imaging modality traditionally used for assessment of pelvic organ prolapse. The utility of TLUS has recently been expanded to the evaluation of synthetic midurethral slings (MUS) surgically implanted for management of stress urinary incontinence. The purpose of this article is to familiarize radiologists with translabial ultrasound technique and provide a technical protocol for TLUS execution because it can be optimized for imaging and assessment of MUS, including identification of MUS configuration and recognition of common complications. This article provides example images of transobturator and retropubic slings and their associated complications, as visualized on TLUS. Accurate imaging and assessment of MUS is helpful in the evaluation of the patient presenting with symptoms suspicious for sling-related complications and in the planning of surgical revision.

Teaching module for three midurethral sling complications Knowledge of urethral closure/opening mechanisms and pathogenesis of SUI informs management of “difficult” cases

Teaching module for three midurethral sling complications Knowledge of urethral closure/opening mechanisms and pathogenesis of SUI informs management of “difficult” cases

Is it the Surgeon? A Re-examination of Mid-urethral Sling Complications

ObjectiveTo identify potential technical factors during initial mid-urethral sling (MUS) placement that contribute to subsequent sling revision procedures. MethodsA retrospective chart review was performed examining synthetic MUS reoperations at a single institution from 2008-2020. The implanting surgeon's operative note, when available, was critically reviewed with respect to trocar placement, sling location, and tensioning technique. The reoperative report was reviewed for aberrant intraoperative findings relating to the index surgery. ResultsA total of 306 women underwent revision of their MUS. Operative reports from the implanting surgeon were available for 276 (90.2%) women. Review of index operative reports revealed 47 unambiguous descriptions of improper technique, including 19 cases of described excessive tensioning and 2 cases of MUS placement despite noted urethral injury during the index case. Indications for reoperation were clinical obstruction (63%), pain (40%), and mesh erosion/exposure (33%). In 186 (67.4%) women, there was an intraoperative finding during the revision that likely contributed to the need for reoperation. Among these 186 women, 110 (59.1%) slings were noted to have been placed too proximally, 78 (41.9%) were over-suspended, and 57 (30.6%) were placed too deep in the periurethral fascia. ConclusionReview of the index operative note and findings at operative re-exploration of MUS surgeries, often reveals evidence that the initial MUS implantation was technically suboptimal. Such findings suggest that intraoperative surgical technique is a critically important factor contributing to postoperative complications in MUS surgery. This underscores the importance of surgical training and adherence to surgical principles during the placement of a synthetic MUS.

Focusing on long-term complications of mid-urethral slings among women with stress urinary incontinence as a patient safety improvement measure: A protocol for systematic review and meta-analysis.

Background:There are 3 different types of mid-urethral sling, retropubic, transobturator and single incision performed for women with stress urinary incontinence. Prior studies comparing these three surgeries merely focused on the successful rate or efficacy. But nevertheless, what is more clinically important dwells upon investigating postoperative complications as a safety improvement measure.Methods:A systematic review via PubMed, Ovid, and the Cochrane Database of Systematic Review and studies were applied based on the contents with clearly identified complications. Selected articles were reviewed in scrutiny by 2 individuals to ascertain whether they fulfilled the inclusion criteria: complications measures were clearly defined; data were extracted on study design, perioperative complications, postoperative lower urinary tract symptoms, postoperative pain, dyspareunia, and other specified late complications.Results:A total of 55 studies were included in the systemic review. Perioperative complications encompassed bladder perforation, vaginal injury, hemorrhage, hematoma, urinary tract infection. There were postoperative lower urinary tract symptoms including urine retention and de novo urgency. Furthermore, postoperative pain, tape erosion/ extrusion, further stress urinary incontinence surgery, and rarely, deep vein thrombosis and injury of inferior epigastric vessels were also reported.Conclusions:Complications of mid-urethral sling are higher than previously thought and it is important to follow up on their long-term outcomes; future research should not neglect to address this issue as a means to improve patient safety.

Mesh Sling Arm Removal for Persistent Pain After an Initial Vaginal Suburethral Mesh Sling Removal Procedure.

Pain is a recognized complication of mid-urethral slings (MUS), which may lead to suburethral sling removal (SSR) alone, or to a more extensive removal approach. We report on the outcomes of women who required an SSR or an additional secondary MUS arm removal for pain only. After Institutional Review Board (IRB) approval, the charts of nonneurogenic women who underwent SSR for pain only were reviewed. Demographic information, MUS type, self-reported pain resolution, and preoperative and postoperative questionnaires, including Urogenital Distress Inventory-Short form question 6 (UDI-6 Q6) scores, were collected for the SSR (group 1) and secondary removal (group 2) groups. Of 52 women who underwent SSR for pain only between 2005 and 2018, 16 (31%) required a secondary procedure to remove the extension arms due to persistent pain after SSR. All women in group 2 experienced pain immediately after SSR (UDI-6 Q6 score of 2 to 3). Patients whose pain improved after SSR presented at a median 61 months after MUS whereas those in group 2 underwent SSR at median 34 months after MUS. Median duration of follow-up in group 2, after the secondary procedure, was 34 months. Over one half of those in group 2 (54%) noticed pain cure/improvement. Seven were left with persistent pain. In women who underwent SSR for pain only, 67% reported pain resolution. An additional procedure to remove the extension arms of the mesh was performed in one third of women for persistent pain after SSR.

Does adjuvant treatment increase risk of midurethral sling complications after concomitant surgery for endometrial cancer and stress urinary incontinence?

Objective: The aim of this study was to compare the rate of midurethral sling complications among women who received adjuvant treatment after sling placement at the time of concomitant surgery for endometrial cancer and stress urinary incontinence (SUI).

MP30-09 SECONDARY MESH SLING ARM REMOVAL FOR PERSISTENT PAIN AFTER AN INITIAL VAGINAL SUB-URETHRAL REMOVAL PROCEDURE FOR PAIN ONLY

INTRODUCTION AND OBJECTIVE:Pain is a recognized complication of mid-urethral slings (MUS) which may lead to sub-urethral sling removal (SSR). A more extensive complete MUS removal upfront has been ...

The Use of Imaging for Synthetic Midurethral Slings.

Ultrasound and magnetic resonance imaging can be used to image midurethral slings, which have may have complications such as pain. There is considerable misunderstanding regarding the utility of the different modalities. This article aims to review the current literature to identify the benefits and limitations of each imaging modality and identify the place that each should have for patients with midurethral sling complications. A literature search was performed, and all relevant articles were identified and reviewed. Different imaging modalities are complementary, but more research is required in this area.

Do we have adequate data to construct a valid algorithm for management of synthetic midurethral sling complications? ICI-RS 2019.

Synthetic midurethral sling (MUS) procedures, purported for the last two decades as the gold standard surgical treatment for stress urinary incontinence, have been increasingly scrutinized in recent years with regard to the rate and severity of complications. During the International Consultation on Incontinence Research Society meeting held in Bristol, UK, in 2019, a multidisciplinary panel held a think tank and discussed the contemporary evidence pertaining to the classification, investigation, and treatment of MUS complications. The current classification system of mesh-related complications was discussed, and shortcomings were identified. The lack of a standardized clinical pathway was noted, and the value of clinical investigations and surgical treatments was difficult to fully evaluate. The paucity of high-level evidence was a common factor in all discussions, and the difficulties with setting up relevant randomized-controlled trials were highlighted. The outcome of the think-tank discussions is summarized with a set of recommendations designed to stimulate future research.

Outcome of surgical management for midurethral sling complications: a multicentre retrospective cohort study.

Suspension of midurethral sling (MUS) surgery in the UK has led to a call for further evidence regarding long-term morbidity and the efficacy of treatments when mesh complications are encountered. We reviewed how many patients who underwent MUS surgery in Teesside, UK, returned to theatre due to a complication and what the outcomes were following this surgical intervention. All patients coded to have undergone an MUS procedure between 1 January 2010 and 31 December 2014 in Teesside were reviewed retrospectively (n= 924). Case notes were analysed for patients who returned to theatre up until December 2017 due to complications related to their original MUS. Seventy-one of 924 (7.7%) women returned to theatre for some form of surgical intervention. There was a statistically significant difference in return-to-theatre rate between the transobturator and retropubic approach groups (63/661; 9.5%; confidence interval (CI) 7.3-11.8% v 8/263; 3.0%; CI 0.96%, 5.1%, odds ratio (OR) 3.35, p = 0.001); 2.8% (26/924) underwent shortening, reburying, incision or MUS excision; 1.0% (9/924) underwent steroid injection along the MUS tract; 1.7% (16/924) underwent surgical treatment of detrusor overactivity; 3.0% (28/924) required further stress incontinence surgery. The risk of unresolved chronic pain post-MUS surgery following treatment of complications was 0.2% (2/924). Our results show a reassuringly low rate of mesh removal following MUS surgery. Furthermore, outcomes were good following surgical management of MUS complications. We advocate compulsory registration of all MUS procedures, follow-up data and complications to provide robust long-term evidence for the future.

The impact of overweight in the efficiency and complications of midurethral sling in patients with stress urinary incontinence: a systematic review and meta-analysis.

To compare the efficiency and complications of normal weight and overweight women with stress urinary incontinence (SUI) after surgery. We searched the PubMed, Embase, and Cochrane Library Databases to identify all compared results, including those involving the terms normal weight, overweight, body mass index (BMI), and SUI. After treatment with surgery, the efficiency (subjective cure rate, objective cure rate, UDI-6, and IIQ-7) and complications were compared between the normal weight and overweight groups. The study inclusion criteria were met by 20 studies involving 3829 patients. The data synthesized from these studies indicated that the subjective and objective cure rates in the normal weight group were significantly more effective than those in the overweight group (RR 1.07; 95% CI 1.04-1.10; P < 0.00001; RR 1.24; 95% CI 1.18-1.30; P < 0.00001), while the IIQ-7 and UDI-6 were no different between the two groups (MD 0.07; 95% CI -1.44 to 1.58; P = 0.93; MD 0.18; 95% CI -1.24 to 1.60; P = 0.81). For the data of complications, only the urgency was more in the overweight group (RR 0.68, 95% CI 0.55-0.84, P = 0.0003). The objective success rate and subjective success rate of the surgery were higher in normal weight patients than those in overweight patients. Also, the side effects between the two groups were not significantly different.

MP75-02 SYNTHETIC MID-URETHRAL SLING COMPLICATIONS: DO PATIENTS BENEFIT FROM SLING REVISION?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy III1 Apr 2018MP75-02 SYNTHETIC MID-URETHRAL SLING COMPLICATIONS: DO PATIENTS BENEFIT FROM SLING REVISION? Elizabeth Dray, Anne Pelletier Cameron, Erin Crosby, Ashley Grable, J Quentin Clemens, John Stoffel, Priyanka Gupta, and Paholo Barboglio-Romo Elizabeth DrayElizabeth Dray More articles by this author , Anne Pelletier CameronAnne Pelletier Cameron More articles by this author , Erin CrosbyErin Crosby More articles by this author , Ashley GrableAshley Grable More articles by this author , J Quentin ClemensJ Quentin Clemens More articles by this author , John StoffelJohn Stoffel More articles by this author , Priyanka GuptaPriyanka Gupta More articles by this author , and Paholo Barboglio-RomoPaholo Barboglio-Romo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2094AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Synthetic mid-urethral slings (MUS) are the most commonly performed treatment for stress urinary incontinence in women. While these procedures are typically safe and effective, complications do occur. The goal of our study was to define the presentation and outcomes of patients who underwent revision/removal of synthetic MUS at our institution. METHODS We performed a retrospective review of 432 women who underwent revision of a synthetic mid-urethral sling at our institution between 2005 and 2016. Patients with a history of vaginal mesh for pelvic organ prolapse were excluded from our analysis. The outcomes assessed were AUA SI, Michigan Incontinence Symptom Index (M-ISI), pad use and post-void residual (PVR). RESULTS Average patient age was 53 and parity was 2.5. The majority of patients had a TVT (172) followed by TOT (182) and minisling (40). The remainder of slings were MUS of unidentified type. Eighty-one patients had undergone prior mesh revisions elsewhere. Patients presented with four primary complaints: mesh exposure or erosion, pain or dyspareunia, incontinence and bladder outlet obstruction. Most patients presented with at least two categories of mesh-related complaints, with the most common presentations being incontinence/pain (84 patients) and mesh exposure/pain/incontinence (74 patients). Patients most commonly underwent partial or complete excision of the vaginal portion of their mesh (110 and 248 patients respectively). Multiple mesh revisions were performed on 43 patients. Average follow-up was 14 months. The majority of patients (302) did not require further incontinence procedures at our institution. Forty-one patients had a sling placed at the time of mesh revision and 89 patients underwent procedures for incontinence at a later date. Clinically and statistically significant improvement was demonstrated on both validated questionnaires postoperatively. The number of patients reporting pain or dyspareunia declined (p<0.001), as well as the number reporting incontinence of any kind (p=0.006). PVR improved from a preoperative average of 91 cc to 48 cc postoperatively (p=0.001) and average pad use improved from 2.1 pads per day to 1.5 pads per day(p=0.003). CONCLUSIONS Despite complex patient presentations, subjective and objective urologic symptom measures significantly improve following MUS revision. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1008 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Elizabeth Dray More articles by this author Anne Pelletier Cameron More articles by this author Erin Crosby More articles by this author Ashley Grable More articles by this author J Quentin Clemens More articles by this author John Stoffel More articles by this author Priyanka Gupta More articles by this author Paholo Barboglio-Romo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Factors Influencing the Rate of Lost to Followup after Suburethral Synthetic Sling Removal

IntroductionWe report on variables associated with lost to followup in women undergoing suburethral synthetic sling removal for complications of mid urethral slings. MethodsFollowing institutional review board approval a prospectively maintained database of consecutive women with nonneurogenic bladder who underwent 1 synthetic sling removal only was reviewed. Data reviewed by a third party investigator included distance traveled for appointment, marital status, employment status, if the patient received primary care from the institution, if patient’s last followup visit was routine or for ongoing urological treatment, type of insurance coverage and UDI-6 (Urogenital Distress Inventory Short Form) questionnaire scores. Patients who did not reach a minimum followup length of 6 months were contacted via phone and interviewed using a standardized script. ResultsFrom 2005 to 2015, 129 patients had a mean followup of 25 months (range 6 to 114). Of the 38 women lost to followup 19 could not be reached and there was 1 nonrecoverable loss due to death. There was a significant increase in patients returning for followup if they had ongoing treatment (p=0.0035). The most commonly reported reasons for lost to followup were distance to the care center and the patient being content with the postoperative outcome. UDI-6 total score decreased significantly after synthetic sling removal in the lost to followup population by an average of 4.2 points (p=0.0337). ConclusionsGeographical factors and ongoing treatment may explain lost to followup in women referred to a tertiary care center for complications of mid urethral slings.

Current Practices in the Surgical Management of Female Stress Urinary Incontinence: A Survey of Canadian Urologists and Gynecologists

IntroductionWe assessed the practices of urologists and gynecologists who manage stress urinary incontinence surgically to examine the impact of the FDA (U.S. Food and Drug Administration) and/or Health Canada statements on pelvic floor mesh. We also determined how urologists and gynecologists manage recurrent stress urinary incontinence and complications of mesh mid urethral slings. MethodsWe conducted an online survey of urologists and gynecologists who were members of the Canadian Urological Association or Society of Obstetricians and Gynaecologists of Canada. ResultsMid urethral sling was the most common surgery for stress urinary incontinence performed by urologists and gynecologists (100% vs 84%, p=0.0002). The majority of respondents (87%, 119 of 137) were aware of the FDA and/or Health Canada statements and 66% of physicians altered the way they counseled patients before mid urethral sling surgery. An equal proportion of urologists and gynecologists altered their surgical management of stress urinary incontinence due to patient concerns (31% vs 36%) and due to FDA and/or Health Canada statements (16% vs 13%). Repeat mid urethral sling was the most common method of treating recurrent stress urinary incontinence and urologists were more likely than gynecologists to manage complications of mid urethral sling (58% vs 41%, p=0.0286). Chronic pain (33%) and vaginal mesh erosion (26%) were the most common concerns overall. ConclusionsMid urethral sling was reported as the most commonly performed surgery for stress urinary incontinence by urologists and gynecologists after the FDA and Health Canada statements. Both groups altered their surgical practices most commonly due to patient concerns, indicating that negative media attention is impacting the way in which urologists and gynecologists practice when surgically managing stress urinary incontinence in Canada. Variation exists between urologists and gynecologists when it comes to managing complications related to mid urethral sling.

Evaluation and Management of Mid-Urethral Sling Complications

Currently, a mid-urethral sling is the standard of care for the treatment of female stress urinary incontinence. However, complications can occur that are unique to polypropylene mesh such as mesh exposure, perforation, or contracture. Other complications such as de novo urgency and/or urgency urinary incontinence (UUI), urinary tract infection, and/or urinary obstruction can also occur. The diagnosis of these complications requires a high index of suspicion, and treatment is critical as these complications can be quite morbid. As such, this review will discuss the most recent literature regarding the intraoperative and post-operative evaluation and management of mid-urethral sling complications.

Indication and Surgical Treatment of Midurethral Sling Complications: A Multicenter Study

Indication and Surgical Treatment of Midurethral Sling Complications: A Multicenter Study