Retropubic Suburethral Sling Research Articles

Severe affection of the obturator nerve in a young patient after tension free vaginal sling placement: Case report of a rare complication and review of the literature

Introduction: Stress urinary incontinence affects up to 50% of women at some point in their lives. Tension-free vaginal mid-urethral sling procedure should be offered as a primary surgical treatment option to women with stress urinary incontinence. Case Report: We report on the case of a 47-year-old patient presenting with heavy buttock and thigh pain, a severe walking disability necessitating the use of a walker after implantation of a retropubic sub-urethral sling (TVT-SERASIS) for the treatment of stress urinary incontinence in an external hospital. During the surgery in our hospital, it was revealed that the sling was placed incorrectly, charging the bladder wall as well as the left obturator nerve. We describe the diagnosis and operative management of this rare, but serious complication. Conclusion: Our case provides supporting evidence for the limited value of imaging tools and the need of a surgical exploration under certain circumstances. In addition, we emphasize that removal of a sub-urethral sling should be performed under laparoscopic visualization when serious adverse events occur. Sub-urethral sling placement should be executed by experienced, dedicated pelvic floor surgeons.

Case report of vaginal erosion and recurrence of stress urinary incontinence due to shallow placement of tension-free vaginal tape

BackgroundSuburethral sling with tension-free vaginal tape (TVT) has become a popular treatment for stress urinary incontinence (SUI). Erosion of the tape into the vaginal is rare. Very few patients present with vaginal tape erosion and recurrence of SUI.Case presentationA 49-year-old female patient with stress urinary incontinence was treated with a retropubic suburethral TVT sling. 2 months later, recurrent symptoms of SUI developed. 6 months later, the patient complained of repeated vaginal discharge and foreign body sensation. Body physical examination revealed a 1-cm-long tape extrusion at the left anterior vaginal wall beside the midline. Cystourethroscopy revealed no urethral mesh erosion. Surgical removal of the extrusion tape revealed that the left arm of the tape was in the vaginal mucosa layer rather than between the whole thickness of the vaginal mucosa and urethral. The tape around the urethral was dissected and removed. A new retropubic tape was placed simultaneously. At the 8-months follow-up after surgery, the patient was continent without tape vaginal exposure.ConclusionsVaginal mesh erosion should be considered in a patient who presents with sustained vaginal discharge after being treated with a suburethral sling. It is important to place the tape between the whole thickness of the vaginal mucosa and the urethral in SUI surgery. A shallow placement of the tape may lead to vaginal tape erosion and recurrence of SUI. These complications can be avoided by following the correct manipulation procedure and referring to the tissue layer anatomy.

The autologous pubovaginal fascial sling: An update in 2019.

The contemporary management of stress urinary incontinence (SUI) has seen renewed interest in the use of autologous fascia for the formation of a retropubic suburethral sling. Traditionally, it has been used in only the most severe of incontinence cases, such as those women with intrinsic sphincter deficiency, or in patients requiring concomitant reconstructive procedures. In the current climate surrounding transvaginal mesh, many doctors and patients are shying away from the less morbid synthetic midurethral sling. International literature has demonstrated that the fascial sling is a safe and efficacious procedure for all patients with SUI, adequately treating both urethral hypermobility and intrinsic sphincter deficiency. This paper will discuss the indications, technique, and outcomes of autologous fascial slings. We will explore the use of fascial slings following failed synthetic slings and also the troubleshooting of commonly encountered issues intra- and postoperatively.

Durability of Retropubic Suburethral Sling Procedure and Predictors for Successful Treatment Outcome in Women With Stress Urinary Incontinence

ObjectiveTo investigate the long-term durability of retropubic suburethral sling procedure for female stress urinary incontinence (SUI) and to identify urodynamic factors that might predict long-term successful outcomes. Materials and MethodsIn total, 286 women who underwent a retropubic suburethral sling for SUI were enrolled in this retrospective survey. Most patients received uroflowmetry, postvoid residual volume study and standardized video urodynamic testing preoperatively and 6 months postoperatively in half of them. Surgical results, demographic characteristics, preoperative and postoperative urodynamic parameters, and postoperative clinical manifestation were retrospectively analyzed. Urodynamic parameters that predict a failure outcome were investigated. ResultsThe median follow-up period was 10 years (4-29 years). The overall subjective cure rate was 80.8%. The success rates of the sling procedures at 3, 5, 10, 15, and 20 years were 89.2%, 87.7%, 78.8%, 68.6%, and 60.0%, respectively. Vaginal delivery and greater parity had negative influence on cure rate (P = .004 and .013, respectively). A significant interaction was detected from the baseline to 6 months between successes and failures for maximum flow rate (Qmax) (P = .007), voided volume (P = .020), and bladder outlet obstruction index (P = .001). Univariate analysis revealed significant decrease of Qmax, volume, and voiding efficiency; and increase of postvoid residual volume, detrusor pressure, and bladder outlet obstruction index in patients with successful outcome. However, multivariate logistic regression failed to find predictive factors for a failure suburethral sling procedure. ConclusionRetropubic suburethral sling has a durable long-term effect for SUI. Slightly increased bladder outlet resistance after retropubic suburethral sling might be helpful for achieving long-term dryness.

Bladder dysfunction does not affect long-term success rate of the retropubic suburethral sling procedure in women with stress urinary incontinence.

This study investigated the long-term success rate of retropubic suburethral sling in the treatment of women with stress urinary incontinence (SUI) and different bladder function. Surgical outcomes of women with SUI undergoing a retropubic suburethral sling procedure between October 1989 and November 2014 were analyzed retrospectively. Bladder function was evaluated in every patient preoperatively using videourodynamic studies. Patients were classified as having stable bladder, detrusor overactivity (DO), or detrusor underactivity (DU). Baseline urodynamic parameters were analyzed and long-term therapeutic outcomes were compared among these three groups. In all, 403 patients underwent sling procedure for SUI. Of these, 291 (72.2%) had a stable bladder, 78 (19.4%) had DO, and 34 (8.4%) had DU. Mean (± SD) patient age was 60.2 ± 11.8 years, and the median follow-up was 97 months (interquartile range 24-325 months). Postoperatively, the overall continence rate was 83.4% (336/403). After surgery, 71 patients (17.6%) complained of dysuria, 14 (3.5%) complained of urgency incontinence, 25 (6.2%) had recurrent SUI requiring a secondary sling procedure, and urethrolysis was performed in 13 (3.2%). In the stable bladder, DO, and DU groups, the 5-year continence rates were 88.6%, 84.1%, and 79.4%, respectively (P = 0.59), whereas the 10-year continence rates were 83.8%, 72.9%, and 79.4%, respectively. Kaplan-Meier survival analysis indicated that the long-term success rate was similar among the three groups (P = 0.39). The overall continence rate was 83.4% and the 10-year continence rate was satisfactory in all bladder function subgroups. Treatment outcomes were the same for women with SUI but different bladder function.

Repeat retropubic suburethral sling procedure is effective for recurrent female stress urinary incontinence.

The aim of the present study was to investigate the effectiveness of repeat retropubic suburethral sling for recurrent stress urinary incontinence (SUI) in women. A retrospective review was performed of 35 women with SUI who underwent repeat retropubic suburethral sling procedures between May 1994 and November 2014. Treatment outcome was assessed directly or by telephone interview. Sling position and urethral incompetence during straining and coughing after the procedure were evaluated. The overall continence rate after repeat suburethral sling procedures was 60% (21/35). Among the 35 women, 19 underwent a simple retropubic suburethra sling procedure and 16 underwent combined suburethral sling and other pelvic floor surgery; the success rate for these 2 groups was 84.2% (16/19) and 31.3% (5/16; P = .001), respectively. The success rate was 60% in patients with normal detrusor function (n = 18/30) and in those with detrusor underactivity (n = 3/5; P = 1.0). For patients with intrinsic sphincter deficiency and bladder base hypermobility, the success rate was 63.6% (n = 14/22) and 53.8% (n = 7/13), respectively (P = .36). Among the 25 patients with transrectal ultrasound follow-up data, the success rate following placement of the second sling at the bladder neck, proximal urethra, middle urethra, and distal urethra was 50% (2/4), 87.5% (7/8), 36.4% (4/11), and 0% (0/2), respectively (P = .122). Repeat suburethral sling procedures for recurrent SUI are safe and effective. The position of the second sling at the proximal urethra resulted in a relatively higher continence rate relative to other sites.

Place of surgery in the management of post-operative chronic pain after placement of prosthetic material based on a series of 107 cases.

The objective of this study was to evaluate the efficacy of surgical removal of prosthetic material, possibly combined with nerve release, on chronic postoperative pain following placement of prosthetic material. Single-tertiary-centre study on 107 patients managed between November 2004 and April 2016 for removal of prosthetic material responsible for postoperative chronic pain: retropubic suburethral sling (n = 32), transobturator suburethral sling (n = 50), prolapse mesh (n = 16), and hernia mesh (n = 9). The primary endpoint was at least 50% reduction of pain evaluated by a pain numerical rating scale (NRS). The mean interval between the initial operation involving placement of prosthetic material and reoperation for removal of prosthetic material was 41.2 ± 35.4 months. In all cases pain apperaed immediately following prosthetic material placement surgery. Pain presented neuropathic features in almost 30% of cases and was poorly systematized in more than one-half The mean follow-up of the study population was 8.4 ± 10.3 months. The mean pain NRS score for the overall population was seven preoperatively and three at last follow-up. At least 50% reduction of the pain NRS score was observed 67% of cases at last follow-up. During follow-up, 45% of patients experienced relapse of the disorder for which the prosthetic material was initially placed with, in particular, a 62% recurrence rate of urinary incontinence after removal of transobturator suburethral tape. Surgical removal of prosthetic material to treat chronic postoperative pain, achieved global improvement of pain in about two-thirds of cases, but with a risk of recurrence of the initial disorders.

855 - Which one stands longer? 20 years experience in retropubic sub-urethral sling surgery for female stress urinary incontinence: Comparison between autologous fascia and prolene mesh

855 - Which one stands longer? 20 years experience in retropubic sub-urethral sling surgery for female stress urinary incontinence: Comparison between autologous fascia and prolene mesh

Retropubic Intracorporeal Placement of a Suburethral Autologous Sling During Robot-Assisted Radical Prostatectomy to Improve Early Urinary Continence Recovery: Preliminary Data

Urinary continence (UC) recovery remains bothersome for patients even after robot-assisted radical prostatectomy (RARP). We describe the first retropubic suburethral autologous sling created and placed during RARP. The surgical technique and preliminary data regarding its effectiveness in improving early UC recovery are presented. Between November 2013 and February 2014, 60 patients who underwent RARP at a single high-volume center were prospectively randomized into sling and nonsling groups. Early UC was assessed at 5 days (time of catheter removal), 10 days, and 30 days postoperatively by the daily number of pads used and the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) score. Sling-related operative time and urethral erosion were also analyzed. Chi-square and independent sample t tests were used to investigate surgical and functional outcomes between groups. Complete data were available for all patients. Mean ± standard deviation (SD) numbers of pads used daily in nonsling and sling groups, respectively, were 1.9 ± 1.2 versus 1.7 ± 1.4 (P = 0.5) at 5 days, 1.8 ± 1.3 versus 1.3 ± 1.3 (P = 0.1) at 10 days, and 1.1 ± 1.2 versus 0.4 ± 0.8 (P = 0.01) at 30 days. At 1 month, mean ± SD ICIQ-UI-SF scores in nonsling and sling groups, respectively, were 4.8 ± 4.6 versus 1.8 ± 3.4 (P = 0.01); sling patients were associated with pad-free status (76% vs 46%, P = 0.03). The advantage in UC recovery was also observed in sling patients at 3, 6, and 12 months postoperatively. Surgical time did not differ between groups, and in sling patients, no cases of urethral erosion or uroflowmetry suggestive of urinary obstruction were found. Limitations included the small sample size and the lack of assessment of morphologic and urodynamic changes produced by the sling. The suburethral autologous sling is technically feasible and may improve early UC recovery after RARP. These preliminary results should be confirmed in a larger sample of patients.

Review on midurethral sling procedures for stress urinary incontinence

Abstract Minimally invasive suburethral slings, namely the retropubic suburethral sling or the tension-free vaginal tape (TVT), has become the mainstay for surgical management of moderate to severe stress urinary incontinence (SUI) taking over the place of Burch's colposuspension after its introduction in the 1990s. Following the introduction of retropubic sling procedures are the transobturator (TVT-O) procedures and the mini-sling procedures. This review attempts to summarize the current trend of midurethral sling (MUS) procedures in the management of SUI.

Double perforation digestive et fasciite nécrosante après bandelette sous-urétrale rétropubienne

A 60-year-old woman without medical history developed after a Tension-free Vaginal Tape (TVT) procedure a necrotizing fasciitis and an abscess. After unadapted initial treatment, surgical procedure revealed 2 bowel perforations caused by the sling. Treatment was achieved by total mesh removal, bowel repair, necrosis excision and vacuum-assisted closure system. This is the first case report about the association of necrotizing fasciitis and double bowel perforations after TVT procedure. Any critical sepsis or with unsatisfactory evolution after retropubic sub-urethral sling has to make look for a digestive wound.

An inelastic retropubic suburethral sling in women with intrinsic sphincter deficiency

We evaluated outcomes of an inelastic retropubic sling in patients with intrinsic sphincteric deficiency (ISD). This is a retrospective review of women diagnosed with ISD according to urodynamic parameters who underwent a retropubic suburethral sling surgery using a tape with minimal elasticity. All patients in the study where followed up at 2, 6, and 24 weeks and yearly. Outcome measures included self-assessed satisfaction, daily incontinence episodes and pad usage, standardized stress test, postvoid residual volume, and surgical complications. Two hundred and forty-seven patients were involved in this study, with a median follow-up of 43 [interquartile range (IQR) 22-77] weeks and a minimum of 12 weeks. Two patients (0.008 %) had a positive stress test postoperatively. There was a decrease in daily incontinence events (median 1.5-0) (p < 0.001) and pad usage per day (median 1.5-0) (p < 0.001). Two hundred and sixteen (87.4 %) patients reported subjective improvement in symptoms. Urinary retention was found in 18 (7.2 %) patients, and 19 (7.7 %) patients required reintervention, mostly with bulking agent injections for persistent incontinence. No tape-related mesh exposures were reported. Retropubic suburethral inelastic slings represent a good option for treating patients with ISD, with satisfactory continent rates and low postoperative complications.

Recurrent mesh erosion and retropubic abscess following anterior intravaginal slingplasty

Anterior intravaginal slingplasty (IVS), which utilizes multifilament polypropylene mesh is associated with significant risk of mesh erosion and infection. A case of mesh erosion occurred at 6 months following retropubic suburethral IVS sling was referred to our clinic. Complete removal of the protruded tape with primary closure of the vaginal defect was performed. However, repeat vaginal erosion was observed 2 years later. The undermined remaining tape further developed a retropubic purulent abscess. Thereafter, complete mesh removal and debridement in the retropubic space was carried out. The retropubic abscess resulted from the remains of the IVS tape. We emphasize that complicated sequel can develop after incomplete removal of IVS tape when tape erosion is encountered.

Novel approach for correction of urethral prolapse using a retropubic sling with urethral fixation

We describe the novel management of a 68-year-old postmenopausal woman with urethral mucosal prolapse, stress urinary incontinence, and significant pelvic organ prolapse. Successful surgical management of her urethral prolapse was achieved using a retropubic suburethral sling with urethral fixation at the time of anti-incontinence and pelvic reconstructive surgery.