Sling Removal Research Articles

Repeat Surgical Intervention for Stress Urinary Incontinence after a Failed Mid Urethral Sling

IntroductionWe determined the incidence of stress urinary incontinence surgery performed after mid urethral sling procedures and the impact of physician volume on mid urethral sling failure. MethodsAdministrative data were used to identify all women who underwent a mid urethral sling procedure in Ontario, Canada between 2002 and 2013. The primary outcome was subsequent stress urinary incontinence surgery. The primary exposure was surgeon mid urethral sling case volume with high volume defined as greater than the 75th percentile. ResultsA total of 59,556 women with a median age of 52 years (IQR 45–63) received a mid urethral sling, of whom 3.3% underwent additional stress urinary incontinence operations. The most common secondary surgery was a repeat mid urethral sling in 78.3% of cases and a pubovaginal sling in 5.8%. The cumulative incidence of repeat stress urinary incontinence surgery at 10 years of followup was 5.2% (95% CI 4.9–5.5). On multivariable survival analysis the effect of surgeon mid urethral sling volume on subsequent stress urinary incontinence surgery was nonsignificant (HR 0.89, 95% CI 0.76–1.03). Younger patient age, lower comorbidity and simultaneous hysterectomy decreased the hazard of future stress urinary incontinence surgery. In this cohort 1,425 women (2.4%) required surgical revision or removal of the initial mid urethral sling, of whom 215 (15%) underwent a simultaneous or subsequent incontinence procedure. The most common procedure was still a mesh sling, which was placed in 159 women (74.0%). ConclusionsSecondary stress urinary incontinence surgery after mid urethral sling placement was observed in 3.3% of women. The majority of women with recurrent incontinence were treated with a repeat mid urethral sling. There is a nonsignificant trend toward higher mid urethral sling provider volume being correlated with a reduced risk of future stress urinary incontinence surgery.

Incontinence rates after midurethral sling revision for vaginal exposure or pain

Midurethral slings have become the preferred surgical treatment for stress urinary incontinence. Midline transection of midurethral sling for dysfunctional voiding is an effective treatment and also has a low rate of recurrent stress incontinence. Recurrent stress incontinence after sling revision for pain and mesh exposure has not been well defined. It is therefore difficult to counsel patients on risk of recurrent stress incontinence when sling revision is performed for pain or mesh exposure. We examined the rate of postoperative stress incontinence after midurethral sling revision for the indication of mesh exposure or pain, as well as postoperative pain and urinary urgency. This is a retrospective cohort of 245 patients undergoing a vaginal midurethral sling revision in a 10-year period for the indication of mesh exposure or pain. Preoperative indication for revision, baseline characteristics, and preoperative reports of stress incontinence, pain, and urgency were collected. The type of sling revision was then categorized into partial or complete removal. A partial removal of the sling was defined as removing only the portion of sling exposed or causing pain. A complete removal of the sling was defined as vaginal removal of sling laterally out to the pubic rami. Subjective reports of stress incontinence, pain, and urgency at short-term (16 weeks) and long-term (>16 weeks) follow-up visits were gathered. The primary outcome of the study was recurrent stress incontinence. In our cohort of 245 women who underwent midurethral sling revision, 94 patients had removal for mesh exposure (36 partial and 58 complete) and 151 had removal for pain (25 partial and 126 complete). All patients had a short-term follow-up with a mean time of 5.9 ± 2.8 weeks and 69% patients had long-term follow-up with a mean time of 29.1 ± 17.7 weeks. No differences were seen in preoperative reports of stress incontinence, urgency, or pain in either group. In the patients with revision for mesh exposure with no preoperative stress incontinence, there was greater postoperative stress incontinence with complete vs partial removal of sling at short-term (14% vs 42%, P= .03) and long-term (7% vs 59%, P= .003) follow-up. In the patients with revision for pain with no preoperative stress incontinence, there was no statistically significant difference in recurrent stress incontinence with complete sling removal at long-term follow-up (22% vs 56%, P= .07). In the patients with midurethral sling revision for pain, 72% of partial and 76% of complete sling removal had resolution of pain postoperatively (P= .66). No difference was seen in postoperative reports of urgency or pain improvement in either group between partial or complete sling removal. In women undergoing midurethral sling revision for mesh exposure, complete sling removal resulted in higher recurrent stress incontinence compared to partial sling removal. For the indication of pain, both partial and complete sling removal improved pain in the majority of patients, but there was no statistically significant difference in recurrent stress incontinence.

Results of collagen sling placement following the partial removal of a synthetic midurethral sling

ObjectiveTo assess results of placement of the Pelvilace collagen sling following partial removal of a primary synthetic sling because of late complications. MethodsA retrospective study was undertaken of patients with late complications after midurethral sling surgery who underwent placement of a Pelvilace sling at a center in the Netherlands between January 2006 and January 2011. A postoperative questionnaire was used to evaluate the continence status and continence-related quality of life. Patients scoring 0 in the Urogenital Distress Inventory stress symptoms section were considered cured. The subjective improvement or deterioration in symptoms was scored using the Patient Global Impression of Improvement (PGI-I). ResultsThe questionnaire was completed and returned by 32 (84%) of 38 patients after a mean follow-up of 54.3 months. Nine (28%) patients were deemed cured. Among 29 patients who had not undergone a third surgery, the PGI-I showed a postoperative improvement in 14 (48%). The other 15 patients rated their postoperative situation as little improved, unchanged, or deteriorated. Further subanalysis showed clear differences in postoperative results between the different types of late complications (erosion and/or displacement). ConclusionThe concomitant placement of a collagen sling following partial removal of a primary polypropylene sling shows reasonable results for specific complications.

S&T-41 IS THERE A DIFFERENCE IN OUTCOME BETWEEN EARLY VERSUS DELAYED REMOVAL OF SUBURETHRAL MID-URETHRAL SLING?

You have accessJournal of UrologyScience & Technology Posters1 Apr 2016S&T-41 IS THERE A DIFFERENCE IN OUTCOME BETWEEN EARLY VERSUS DELAYED REMOVAL OF SUBURETHRAL MID-URETHRAL SLING? Himanshu Aggarwal, Jeannine Foster, Nirmish Singla, Feras Alhalabi, Gary Lemack, and Philippe Zimmern Himanshu AggarwalHimanshu Aggarwal More articles by this author , Jeannine FosterJeannine Foster More articles by this author , Nirmish SinglaNirmish Singla More articles by this author , Feras AlhalabiFeras Alhalabi More articles by this author , Gary LemackGary Lemack More articles by this author , and Philippe ZimmernPhilippe Zimmern More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2870AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A common thinking is that women who undergo delayed suburethral synthetic sling removal (SSR) will have a worse outcome. We evaluated the differences in presentation and outcomes of early (<5 years) versus delayed (> 5 years) SSR in women with mid-urethral sling (MUS) complications requiring surgical removal. METHODS A prospectively maintained, institutional review board approved, database of consecutive non-neurogenic women who underwent SSR for MUS complications and were followed for 6 months minimum was reviewed. Exclusion criteria included women with existing vaginal mesh in place, those who underwent concomitant vaginal mesh removal or concomitant surgery, or had 2 MUS removed. All MUS excisions were performed vaginally under general anesthesia with the aim of removing as much MUS as possible. Indications for SSR and outcomes at the last visit were classified based on patient self-reporting. RESULTS From 2005 to 2015, 116 of 360 women were included in the final analysis. Patients were divided into 2 groups: Group 1: N= 73 early sling removal (< 5 years from placement of sling) and Group 2: N= 43 delayed sling removal (= 5 years from placement of sling). Baseline characteristics were similar in these 2 groups except for the median follow-up (significantly longer in Group 1 at 20 months over 13 months for Group 2). There were no differences in self-reported presenting symptoms between groups. All women reported significant improvement in their presenting symptoms in both groups except for urinary urgency incontinence and urge predominant mixed incontinence in Group 2 (Table 1). Women in Group 1 required significantly higher number of bulking agents and overall interventions for SUI than patients in Group 2 (p= 0.02 and 0.03 respectively). CONCLUSIONS Delayed removal of sling > 5 years after placement can still lead to significant improvement in symptoms related to MUS complications. Urge incontinence and urge predominant mixed urinary incontinence is less likely to improve in these women than when the removal is done at an earlier stage. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e325 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Himanshu Aggarwal More articles by this author Jeannine Foster More articles by this author Nirmish Singla More articles by this author Feras Alhalabi More articles by this author Gary Lemack More articles by this author Philippe Zimmern More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

18: Incontinence rates after midurtheral sling revision for vaginal exposure or pain

We describe the rate of postoperative urinary incontinence (UI) after midurethral sling (MUS) revision for the indication of vaginal mesh exposure and vaginal pain, as well as postoperative complaints of urgency and pain. This is an IRB approved retrospective cohort of patients who had undergone a vaginal synthetic mesh MUS sling revision at our institution from May 2004 to May 2014 for the indication of mesh exposure or pain. The preoperative indication for revision was collected as well as baseline characteristics including preoperative complaints of UI, pain and urgency. The type of sling revision was then separated into partial excision or complete excision. A partial removal of the sling was defined as removing only the portion of the sling that was exposed or causing pain. A complete removal of the sling was defined as both arms of the sling dissected out to bilateral pubic rami and then excised. Postoperative visits were reviewed for subjective complaints of UI, pain and urgency at short term (</= 16 weeks) and long term (>16 weeks) visits. The primary outcome of the study was recurrent rate of UI and the secondary outcomes were postoperative pain and urgency rates. Statistics were performed using Stata Statistical Software: Release 13. (StataCorp. 2013. College Station, TX). Ninety-four patients were identified to have undergone vaginal MUS removal for the indication of mesh exposure; 36 (38%) were partial and 58 (62%) were complete removal of the sling material. One hundred fifty-one patients were identified to have vaginal sling removal for the indication of pain; 25 (17%) had partial and 126 (83%) had complete removal of their sling. All patients had a short term follow up visit with a median follow up time of 5.9 weeks and 69% patients had a long term follow up visit with mean follow up time of 29 weeks. No difference was seen in preoperative complaints of UI, urgency or pain in either groups between the revision types performed. In the patients with the indication of mesh exposure with no preoperative complaint of UI, there is a significant increase in postoperative UI with complete excision versus partial excision of the sling at short term and long term follow up. In the patients with the indication of pain, a trend toward increase in newly reported postoperative UI with complete excision of the sling was seen at long term follow up, but this was not significant (Table 1). In the pain patients, 72% of partial excision and 76% of complete excision patients had resolution of their pain post operatively. No difference was seen in postoperative complaints of urgency or pain in either groups between the revision types performed. There is a difference in incontinence rates after partial and complete vaginal excision of MUS for the indication of mesh exposure and possibly for the indication of pain, with complete excision bearing the highest risk of postoperative incontinence in this cohort.

903 Residual pelvic pain/dyspareunia management after synthetic vaginal mesh and/or sling removal

903 Residual pelvic pain/dyspareunia management after synthetic vaginal mesh and/or sling removal

30 Magnetic resonance neurography for residual pelvic pain after synthetic vaginal mesh and/or sling removal

30 Magnetic resonance neurography for residual pelvic pain after synthetic vaginal mesh and/or sling removal

902 Is there a difference in outcome between early versus delayed removal of suburethral mid-urethral sling?

902 Is there a difference in outcome between early versus delayed removal of suburethral mid-urethral sling?

3 Mid-term outcomes following sub-urethral synthetic sling removal in women

INTRODUCTION AND OBJECTIVES: Midurethral slings are most commonly performed procedure for treatment of Stress Urinary incontinence (SUI). With the limitations attributed to synthetic materials, there continues to be an unmet for improved biomaterials that exhibits the attributes of synthetic material and potentially avoids the negative aspects. Our aim is to examine the biocompatibility of our woven collagen mesh with different crosslinking: Genipin and 1-ethyl-3-dimethylaminopropyl carbodiimide & N-hydroxy succinimide (EDC); against commonly used biomaterials (Prolene and xenograft). METHODS: Collagen solution derived from bovine corium was electrochemically aligned into threads and crosslinked with either Genipin or EDC, then woven into a macroporous mesh. A total of 15 Sprague Dawely rats were randomly grouped into 3 time points: 2 weeks, 8 weeks and 20 weeks. Four different scaffolds were implanted subcutaneously in the abdomen per animal, one each of 1 x 1 cm mesh of Xenmatrix, Prolene, Genipin collagen and EDC collagen. At respective time points, scaffolds were harvested and fixed for a week then sent for histology. Scoring was done by senior pathologist in accordance with ISO 10399. Slides were also scanned for image analysis using ImageJ. Statistical analysis was done using IBM SPSS software. RESULTS: There is no significant acute or chronic inflammation in all materials. Collagen mesh presented favorable biocompatibility scores comparable to Prolene at all time points. Xenmatrix meshes were totally encapsulated and lacked tissue integration with no evidence of cellular infiltration, neovascularization or collagen deposition inside the material at all time points. (see Table 1 for complete results). Although significant microscopic degradation of collagen threads over time, the rate of collagen remodeling recovered collagen density at 5 months (figure 1). CONCLUSIONS: Macroporous Collagen mesh allowed tissue integration & new collagen deposition comparable to Prolene mesh. Thus, our novel mesh has a promising potential in incontinence and pelvic floor reconstruction. Source of Funding: none

Obturator Neuralgia: Complete Resolution after Laparoscopic Retropubic Sling Removal: A Report of 2 Cases

Background: Groin pain has been reported more frequently with transobturator mesh tape slings (TOT) compared to retropubic mesh tape slings (RP) secondary to the position of the mesh in the groin relative to the obturator nerve. However, if the mesh of a RP sling is placed on or near the region of the obturator neurovascular bundle in the retropubic space, the potential for similar groin pain does exist. Cases: We report two cases of severe leg and groin pain following the placement of a RP mesh tape sling. Two premenopausal women suffered groin pain after RP sling insertion. The RP slings were successfully removed by a combined laparoscopic and vaginal approach and both patients’ pain resolved. Conclusion: Laparoscopic RP sling removal from the retropubic space is safe and should be consider in patient who has obturator neuralgia after RP sling insertion.

Laparoscopic Burch urethropexy at time of mesh sling removal: A cohort study evaluating functional outcomes and quality of life

Laparoscopic Burch urethropexy at time of mesh sling removal: A cohort study evaluating functional outcomes and quality of life

The IUGA/ICS classification of synthetic mesh complications in female pelvic floor reconstructive surgery: a multicenter study.

The objective was to report patterns of sling and transvaginal mesh-related complications using the IUGA/ICS classification of prosthesis-related complications. This was a retrospective chart review of all patients who underwent surgical removal of sling, transvaginal mesh, and sacrocolpopexy for mesh-related complications from 2011 to 2013 at three tertiary referral centers. The International Urogynecological Association (IUGA)/International Continence Society (ICS) classification system was utilized. We identified 445 patients with mesh complications, 506 pieces of synthetic mesh were removed, and 587 prostheses-related complications were classified. 3.7% of patients had viscus organ penetration or vaginal exposure as their presenting chief complaint and 59.7% were classified as not having any vaginal epithelial separation or category 1. The most common category was spontaneous pain (1Be: 32.5%) followed by dyspareunia (1Bc: 14.7%). The sling group was 20% more likely to have pain compared with the pelvic organ prolapse (POP) mesh group (OR 1.2, 95% CI 0.8-1.6). The most commonly affected site (S2) was away from the suture line (49%). Compared with the sling group, the POP group had a higher rate of mesh exposure, which mostly occurred at the suture line area. The majority of patients presented with mesh-related complications more than 1year post-insertion (T4; average 3.68 ± 2.47years). Surgeons should be aware that patients with vaginal mesh complications routinely exhibit complications more than 1year after the implantation with pain as the most common presenting symptom.

Outcomes Following Combined Laparoscopic Burch Urethropexy at Time of Mesh Sling Removal: A Prospective Cohort Study.

Outcomes Following Combined Laparoscopic Burch Urethropexy at Time of Mesh Sling Removal: A Prospective Cohort Study.

Vaginal excision of the sub-urethral sling: analysis of indications, safety and outcome.

IntroductionSling techniques are the method of choice in stress urinary incontinence management, despite the high rates of complications leading sometimes to the necessity of re-operation, and the tape transection and resection are of the greatest importance. The study was aimed at analyzing the indications, technique and effects of transvaginal tape excision.Material and methodsA retrospective study including 100 patients who underwent surgical removal of the sub-urethral sling in Evangelisches Krankenhaus Hagen-Haspe was conducted. The analyzed measures were: sling type, onset of symptoms, rates of particular complications, safety and outcome of the operative procedure.ResultsMost complications occurred in the first 2 years after surgery. The most common indications for re-operation were: overactive bladder (OAB) (64%), persistent stress urinary incontinence (SUI) (59%), pain (40%), urinary retention (40%), and erosion (29%). Some of the complications co-existed (i.e. vaginal erosion with postoperative pain, infections with urinary retention). During the procedure 1 bladder was injured and 1 patient had a hematoma. In women with OAB, 24-hour frequency decreased from 13.3 to 8.5 (p < 0.001), the mean voiding volume increased from 131.7 to 216.4 ml (p < 0.001), and nocturia increased from 3.28 to 1.19 (p < 0.001). Intensity of urgency decreased from 8.78 to 0.92 in the 10-point visual score (p < 0.001). Pain and urinary retention resolved in 39 out of 40 patients (p < 0.0001). The rate of SUI increased from 59% to 83% (p < 0.001).ConclusionsSling removal is safe and associated with a minimal rate of complications. Removing the tape causes resolution of most of the complications, but SUI recurs or worsens.

Urodynamics for incontinence after midurethral sling removal.

We reviewed the role of urodynamics (UDS) in the management of women with incontinence following mid-urethral sling removal (MUSR). Following IRB approval, women from a longitudinal database who had persistent or recurrent urinary incontinence (UI) after MUSR, desired further therapy, and subsequently underwent UDS were reviewed. Women with neurogenic bladder, obstructive symptoms without UI, urethra-vaginal fistula, anterior compartment prolapse >Stage 2, or those who had concomitant autologous sling surgery at the time of MUSR were excluded. Interval time between MUSR and UDS, UDS findings, and UI management after UDS were recorded. From 2006 to 2013, 71 of 246 women had UDS after MUSR for persistent or recurrent UI. For the 54 women in the final analysis, mean time between tape removal and UDS was 12.4 months (range: 4-65). UDS demonstrated incontinence in 78% of patients: stress urinary incontinence (SUI) in 19 (35%), detrusor overactivity incontinence (DOI) in 6 (11%), and mixed urinary incontinence (MUI) in 17 (32%). On pressure-flow studies, the following voiding patterns were demonstrated: normal voiding (39), valsalva voiding (6), obstruction (2), underactive detrusor (1), no voiding records (6). UDS storage and emptying data were used in subsequent symptom-based patient counseling for treatment planning. Urethral bulking agent was the most commonly chosen management (43%). Our current guidelines for UDS in women after incontinence procedures and MUSR are currently based on a low level of evidence. This study reinforces the role of UDS to guide therapy for UI after MUSR. Neurourol. Urodynam. 35:939-943, 2016. © 2015 Wiley Periodicals, Inc.

Outcomes of Male Sling Mesh Kit Placement in Patients with Neuropathic Stress Urinary Incontinence: A Single Institution Experience

Background and Objectives: The mainstay of therapy in patients with neuropathic stress urinary incontinence (nSUI) has been through the use of artificial urinary sphincter (AUS). AUS infection/erosion rates are higher in nSUI patients and these patients tend to be younger, increasing the likelihood of multiple AUS revisions in the future. We review our experience with mesh male slings for patients with nSUI. Methods: A retrospective review of patients who had mesh sling placement. Results: Twenty patients were identified between 2003 and 2011. 14/20 (70%) (5 = AdVance, 8 = InVance, 1 = Virtue) were available for long-term evaluation; in 6/20 (30%) the sling was removed for either infection or perineal wound breakdown. The mean time from injury to male sling was 148.2 (29-449) months. Pre-/post-op fluorourodynamic study was performed in 13 and 7 patients, respectively. There were no significant differences in ALPP (46.4 vs. 55.7 cm H₂O, p = 0.106) and MCC (456.6 vs. 608 ml, p = 0.21) in the 7 patients who had a post-op study: five patients had new onset low bladder compliance and two had new onset detrusor overactivity post-sling. With a mean follow-up of 24.7 (1-66) months, 4/14 (28.6%) had no UI. Conclusions: With short-term follow-up, mesh male slings are a feasible option to treat nSUI. There appears to be a lower success rate for UI resolution, which may be attributable to new onset detrusor failure or wound infection requiring sling removal.

MP81-10 LONG-TERM RESULTS OF SALVAGE AUTOLOGOUS FASCIAL SLING PLACEMENT FOLLOWING FAILED SYNTHETIC MIDURETHRAL SLING FOR STRESS URINARY INCONTINENCE IN WOMEN

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology1 Apr 2015MP81-10 LONG-TERM RESULTS OF SALVAGE AUTOLOGOUS FASCIAL SLING PLACEMENT FOLLOWING FAILED SYNTHETIC MIDURETHRAL SLING FOR STRESS URINARY INCONTINENCE IN WOMEN Steven Petrou, Andrew Davidiuk, Bhupendra Rawal, and David Thiel Steven PetrouSteven Petrou More articles by this author , Andrew DavidiukAndrew Davidiuk More articles by this author , Bhupendra RawalBhupendra Rawal More articles by this author , and David ThielDavid Thiel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2888AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The optimal method of salvaging failed midurethral slings is not well defined. Our objective was to determine long-term surgical outcomes for women who underwent salvage autologous fascial sling (AFS) placement after a failed synthetic midurethral sling (MUS). METHODS Following IRB approval, women who had undergone AFS placement without concomitant pelvic surgery for a failed MUS utilizing mesh more than 36 months prior were identified. Patients were contacted by telephone and administered the Patient Global Impression of Improvement (PGI-I) questionnaire and the urgency portion of the Medical, Epidemiologic, and Social Aspects of Aging (MESA) questionnaire. Previous records were reviewed, and recorded parameters included date of surgery, if the failed sling was removed concomitantly; age at time of surgery; type of failed operation (transobturator versus RP mesh sling); date of last face-to-face clinic visit and continence status at that time; and whether the patient had a component of urinary urgency at the time of the second sling operation. Statistical analysis of data utilized either Fisher exact or Wilcoxon rank sum exact. RESULTS Seventeen patients were successfully contacted by telephone. Median age at surgery was 66 years (range: 53-81). Eleven (64.7%) had documented urinary urgency pre-operatively, and eight (47.1%) had concomitant sling excision at the time of the salvage operation. The mean age of patients surveyed was 71 years (range: 63-84), with median follow-up of 66 months (range: 36-127). Mean MESA urgency score was 28 (range: 0-94). Total success as scored by the PGI-I was noted in 12 patients (70.6%). One patient required additional anti-incontinence surgery (5.9%). Positive surgical recommendation was given by 14 patients (82.4%). No patient required clean intermittent catheterization. A high MESA urgency score was significantly associated with non-success (P=0.024). No statistical impact was noted with sling excision (P=0.62), preop urgency (P=0.06), age at surgery (P=0.10), age at follow-up (P=0.064), or longer length of follow-up (P=0.51). The study was limited by the its small sample size. CONCLUSIONS Our findings indicated that an AFS provides reasonable long-term success as a salvage operation for failed mid-urethral slings secondary to stress urinary incontinence. Removal of the primary synthetic sling does not appear to impact the success rates of the operation. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1032-e1033 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Steven Petrou More articles by this author Andrew Davidiuk More articles by this author Bhupendra Rawal More articles by this author David Thiel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V2-03 PUBOVAGINAL SLING WITH TENSOR FASCIA LATA

You have accessJournal of UrologyFemale Voiding Dysfunction1 Apr 2015V2-03 PUBOVAGINAL SLING WITH TENSOR FASCIA LATA Judy M. Choi, Patkawat Ramart, Diana Kang, Seth Cohen, Lenny Ackerman, and Shlomo Raz Judy M. ChoiJudy M. Choi More articles by this author , Patkawat RamartPatkawat Ramart More articles by this author , Diana KangDiana Kang More articles by this author , Seth CohenSeth Cohen More articles by this author , Lenny AckermanLenny Ackerman More articles by this author , and Shlomo RazShlomo Raz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.328AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of autologous fascia for the treatment of stress urinary incontinence has been well-established, with the most common sites of harvest including the rectus fascia and tensor fascia lata. In the past we preferred the use of rectus fascia for our fascial slings, but due to an increase in patients with elevated BMIs and complicated histories of abdominal surgery, we have transitioned to the use of tensor fascia lata. We describe our surgical technique and outcomes with the pubovaginal sling using tensor fascia lata. METHODS A retrospective review was performed using medical records of patients at our tertiary care center who had undergone pubovaginal slings with tensor fascia lata for stress urinary incontinence from January 2014 to October 2014. With the patient in the lateral position, tensor fascia lata was harvested through a single incision in the lateral thigh, utilizing the Crawford stripper. The patient was then repositioned into the dorsal lithotomy position for standard pubovaginal sling placement. RESULTS Pubovaginal sling with tensor fascia lata was performed in 22 patients. Mean age was 55.8 years, and mean BMI was 29.5. 15/22 (68.2%) had undergone previous abdominal surgery, and 20/22 (91.0%) had undergone prior mesh sling removal. Mean hospital stay was 1.09 days. 2/22 (9.1%) of patients developed complications following the procedure, including one pelvic hematoma and one incisional hematoma at the site of the fascial harvest. None complained of leg pain or difficulties ambulating at their initial post-operative visit, and all reported improvement in continence at their first post-operative visit. CONCLUSIONS Based on our initial experience, we have found the use of tensor fascia lata in autologous fascial slings to be less challenging, especially in patients with elevated BMIs and in those with a history of multiple abdominal surgeries. Pubovaginal slings using tensor fascia lata was found to be safe and well-tolerated in patients requiring treatment for stress urinary incontinence. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e98 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Judy M. Choi More articles by this author Patkawat Ramart More articles by this author Diana Kang More articles by this author Seth Cohen More articles by this author Lenny Ackerman More articles by this author Shlomo Raz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Creating a gold standard surgical device: scientific discoveries leading to TVT and beyond: Ulf Ulmsten Memorial Lecture 2014.

The discovery of tension-free vaginal tape (TVT) began in 1986 with two unrelated observations: pressure applied unilaterally at the midurethra controlled urine loss on coughing; implanted Teflon tape caused a collagenous tissue reaction. In 1987, Mersilene tape was implanted retropubically in 13 large dogs, with the aim of creating an artificial collagenous pubourethral neoligament. Extensive testing showed that the operation was safe and effective. In 1988-1989, human testing was carried out (n = 30). Mersilene tape cured 100 % of stress and mixed incontinence with a sling in situ; however, there was simultaneous recurrence of the two symptoms in 50 % on sling removal. X-rays showed no elevation of the bladder neck. In 1990-1993, collaboration with Ulf Ulmsten took place: a permanently implanted tape was required. Polypropylene was the ideal material. In 2003, the neoligament principle was applied as an adjustable "micro" sling to the arcus tendineus fasciae pelvis (ATFP), cardinal, uterosacral ligaments, and perineal body for cure of cystocele, rectocele, and apical prolapse. It was found that symptoms such as urgency, nocturia, chronic pelvic pain, obstructive defecation syndrome (ODS), and fecal incontinence were frequently cured or improved. The lecture concluded with advice to younger members. Without new paradigms, there are no randomized controlled trials, no meta-analyses, Cochrane. Indeed, no progress. Be open to new concepts. Read Kuhn's "The Structure of Scientific Revolutions" to understand the discovery process. Examine the relationship among symptoms, ATFP, cardinal, uterosacral ligaments, and the perineal body. This is the next paradigm. Don't disregard anomalies. Pursue them. They are the pathway to discovery. Innovation is born from challenge, not conformity. Persist, even when meeting resistance. Resistance is a sign that your discovery is important.

Removing a Misplaced Retropubic Midurethral Sling From the Urethra and Bladder Neck Using Ear, Nose, and Throat Instruments

The retropubic tension-free vaginal tape (TVT) procedure is a common procedure with complications attributed to voiding dysfunction, bladder perforation, and bleeding. We present a case of successful removal of a retropubic midurethral sling from the urethra using a head lamp and a combination of ear, nose, and throat instruments. A 63-year-old woman presented to our clinic with the symptom of gross hematuria after having undergone a TVT procedure. On office cystoscopy, the sling was noted to be placed within the urethral mucosa. Removal of the mesh was performed using a nasal speculum, left and right ethmoid scissors, left and right Blakesley graspers, and a head lamp to dissect the mesh directly out of the urethra. The utilization of ear, nose, and throat tools allowed us to resect the intraurethral mesh without necessitating incision of the urethral sphincter.