Sling Release Research Articles

8772 The Impact of Acute Urinary Retention Volume on Postoperative Urinary Dysfunction Following Robotic Sacrocolpopexy

<h3>Study Objective</h3> Sacrocolpopexy (SCP) for pelvic organ prolapse is typically performed with a midurethral sling (MUS) to treat or prevent postoperative stress urinary incontinence (SUI). A known complication is the development of postoperative urinary dysfunction, namely obstructed voiding, chronic urinary retention (CUR) and eventual sling release. This study aims to investigate whether the degree of acute urinary retention (AUR) is predictive of longer-term sequelae. <h3>Design</h3> Retrospective case control study. <h3>Setting</h3> Academic-affiliated community hospital. <h3>Patients or Participants</h3> All patients (n=708) undergoing a robotic SCP with transobturator MUS placement by a single urogynecologist between January 2012 and March 2022 stratified by their post-void residual bladder volumes (PVRBV) were included in this study. <h3>Interventions</h3> Patients were grouped by their degree of PVRBV: ≤150mL (n=397), >150 and ≤300mL (n=111), >300 and ≤450mL (n=84), and >450mL (n=116). <h3>Measurements and Main Results</h3> Higher volumes of AUR had a statistically significant increase in the percentage chance risk of CUR. (6.3%, 16.2%, 10.7%, 14.7%, p<0.05). A non-statistically significant distribution was observed between PVRBV and requirement for eventual sling release (3%, 1.8%, 0%, 6%, p=0.08). There were no differences in other long term postoperative sequelae amongst variable degrees of acute PVRBV including urinary symptoms, need for postoperative medications or return to the emergency department or hospital readmissions. Patients with greater PVR volumes had lower body mass index (28.7, 27.7, 27.2, 26.8 kg/m², p<0.05). Other demographic variables were similar amongst groups. <h3>Conclusion</h3> Increasing BMI has a protective effect from developing CUR. Higher PVRBV in excess of 150mL were associated with a greater propensity for CUR. This had a trend toward requiring sling release and/or revision. Future studies are necessary to determine whether the degree of AUR is related to the procedure or pre-existing bladder dysfunction.

Feasibility of combining pelvic reconstruction with gynecologic oncology-related surgery.

At our institution, every patient seen by the gynecologic oncology service is screened for pelvic floor dysfunction. This study was aimed at determining if a combined surgical approach by gynecologic oncology and urogynecology services at our institution was feasible and safe for this patient population. We performed a retrospective review of patients undergoing combined surgery by gynecologic oncology and urogynecology services at our institution from 2013 to 2021. Perioperative variables, postoperative adverse events, and long-term outcomes were assessed, and descriptive statistics were performed. From 20 December 2013 to 29 January 2021, a total of 102 patients underwent concurrent surgical repair of pelvic organ prolapse and/or stress urinary incontinence. Seventy-three patients (71.6%) had normal/benign pathologic conditions, and 29 (28.4%) had premalignant/malignant pathologic conditions. Ten patients (9.8%) had a postoperative complication, including reoperation for exposed midurethral sling (4.9%), urinary retention requiring midurethral sling release (2.9%), reoperation for hemoperitoneum (1.0%), and anemia requiring blood transfusion (1.0%). Nine complications occurred in patients with benign/normal pathologic conditions (12.3%), and one complication occurred in patients with pre-malignant/malignant pathologic conditions (3.4%). In our single-institution experience, concurrent gynecologic oncology and pelvic floor reconstructive surgery were safe and feasible in combination with no reported major morbidity events.

AUTOLOGOUS TRANS-OBTURATOR (ATO) RECTUS FASCIA SLING IN TREATMENT OF FEMALE STRESS URINARY INCONTINENCE

Background: stress urinary incontinence is a common problem affecting females; treatment varies between Burch colposuspension and traditional tot using synthetic materials. Objective: To evaluate efficacy and safety of autologous transobturator (ATO) rectus fascia sling as a primary treatment for female stress urinary incontinence. Materials and Methods: We evaluated the outcomes of 56 consecutive females who underwent ATO sling placement with rectus fascia for stress incontinence from July 2017 to September 2019 at the urology department – Al Azhar university hospitals (Alhussien – Sayed Galal university hospitals). Patients were followed in the outpatient clinic after one week, two weeks, 3 months and 6 months postoperatively. Outcomes were measured subjective by the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) score, and patient reported outcome and objective by cough stress test. ICIQ-FLUTS were compared between pre- and postoperative responses using Wilcoxon signed-rank test. Retreatment-free survival rates were evaluated via Kaplan-Meier method. Results: The mean age of patients was 43.4 ± 7.04 years (29-56 years), 40 patients (71.5%) were premenopausal, and 16 patients (28.5%) were postmenopausal. The mean BMI was 29.2 ± 4.1 kg/m². The technique was performed and the patient was discharged the next day after surgery. Follow up for patients was carried out at one week, two weeks, three and six months postoperatively. All patients completed ICIQ-FLUTS at the last follow-up. Compared to preoperative scores, patients who completed ICIQ-FLUTS questionnaires at 6 months (N = 56) showed significant improvement in all domains: frequency, voiding, and incontinence, and in quality of life related to frequency, voiding and incontinence. Among those who completed questionnaires both at 3 months and 6 months after surgery (N = 56). There was no significant deterioration in ICIQ-FLUTS scores. Overall retreatment-free survival rate was 93% at six months. Notably, none of our patients suffered from severe (Clavien III-V) complications or required sling release. Conclusion: ATO sling placement appeared safe and effective, with promising short-term outcomes. However, long term follow-up is needed.

AUTOLOGOUS TRANS-OBTURATOR (ATO) RECTUS FASCIA SLING IN TREATMENT OF FEMALE STRESS URINARY INCONTINENCE

Background: stress urinary incontinence is a common problem affecting females; treatment varies between Burch colposuspension and traditional tot using synthetic materials. Objective: To evaluate efficacy and safety of autologous transobturator (ATO) rectus fascia sling as a primary treatment for female stress urinary incontinence. Materials and Methods: We evaluated the outcomes of 56 consecutive females who underwent ATO sling placement with rectus fascia for stress incontinence from July 2017 to September 2019 at the urology department – Al Azhar university hospitals (Alhussien – Sayed Galal university hospitals). Patients were followed in the outpatient clinic after one week, two weeks, 3 months and 6 months postoperatively. Outcomes were measured subjective by the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) score, and patient reported outcome and objective by cough stress test. ICIQ-FLUTS were compared between pre- and postoperative responses using Wilcoxon signed-rank test. Retreatment-free survival rates were evaluated via Kaplan-Meier method. Results: The mean age of patients was 43.4 ± 7.04 years (29-56 years), 40 patients (71.5%) were premenopausal, and 16 patients (28.5%) were postmenopausal. The mean BMI was 29.2 ± 4.1 kg/m². The technique was performed and the patient was discharged the next day after surgery. Follow up for patients was carried out at one week, two weeks, three and six months postoperatively. All patients completed ICIQ-FLUTS at the last follow-up. Compared to preoperative scores, patients who completed ICIQ-FLUTS questionnaires at 6 months (N = 56) showed significant improvement in all domains: frequency, voiding, and incontinence, and in quality of life related to frequency, voiding and incontinence. Among those who completed questionnaires both at 3 months and 6 months after surgery (N = 56). There was no significant deterioration in ICIQ-FLUTS scores. Overall retreatment-free survival rate was 93% at six months. Notably, none of our patients suffered from severe (Clavien III-V) complications or required sling release. Conclusion: ATO sling placement appeared safe and effective, with promising short-term outcomes. However, long term follow-up is needed.

Can Urodynamic Parameters Predict Sling Revision for Voiding Dysfunction in Women Undergoing Synthetic Midurethral Sling Placement?

The objective of the study was to evaluate the utility of urodynamic studies performed before primary midurethral sling placement for stress urinary incontinence in predicting the need for subsequent sling release for voiding dysfunction. The health records of women managed with primary synthetic midurethral sling placement at Mayo Clinic (Rochester, MN) from January 1, 2002, to December 31, 2012, were reviewed. The primary outcome was surgical sling release for postoperative voiding dysfunction (ie, prolonged retention, elevated postvoid residual volumes with new voiding symptoms, or de novo onset or worsening of overactive bladder symptoms). Logistic regression models were used to evaluate associations between potential clinical risk factors and the primary outcome. Overall, 1629 women underwent primary synthetic midurethral sling placement during the study time frame, including 1081 patients (66%) who underwent a preoperative multichannel urodynamic evaluation. A sling release for voiding dysfunction was performed for 51 patients (3.1%) at a median of 1.9 months postoperatively (interquartile range, 1.3-9.3 months). Patients undergoing sling release were significantly more likely to have had retropubic sling placement (P = 0.003) and concomitant prolapse surgery (P = 0.005). On univariate analysis, no urodynamic parameters were associated with the risk of sling release; evaluated parameters included peak flow rate (P = 0.20), postvoid residual volume (P = 0.37), voiding without detrusor contraction (P = 0.96), and detrusor pressure at maximal flow (P = 0.23). Sling release for voiding dysfunction was rare in our cohort. No urodynamic parameters were associated with the risk of sling release.

MP46-16 POST-OPERATIVE TRANSOBTURATOR MALE SLING URINARY RETENTION RESOLVES SPONTANEOUSLY WITH TIME AND MAY BE ASSOCIATED WITH HIGHER LONG-TERM SUCCESS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy1 Apr 2017MP46-16 POST-OPERATIVE TRANSOBTURATOR MALE SLING URINARY RETENTION RESOLVES SPONTANEOUSLY WITH TIME AND MAY BE ASSOCIATED WITH HIGHER LONG-TERM SUCCESS Divya Ajay, Bryce Allio, Ramiro Madden-Fuentes, and Andrew Peterson Divya AjayDivya Ajay More articles by this author , Bryce AllioBryce Allio More articles by this author , Ramiro Madden-FuentesRamiro Madden-Fuentes More articles by this author , and Andrew PetersonAndrew Peterson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1455AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Post-operative urinary retention (POUR) has been reported in 3-21% of patients undergoing a male transobturator sling (TOS) for post-prostatectomy urinary incontinence (PPUI). Our objective was to examine the natural history of POUR in men undergoing TOS, and review the treatment options and resolution rates to propose an algorithm for management. METHODS We reviewed men undergoing a TOS at our institution from 2006 to 2012. Demographic data, post-operative complications and outcomes were extracted by chart review. Post-operative TOS success was defined as the use of 0 or 1 security pads/day, negative stress test on exam or pad weight less than 8 g/day. POUR was defined as patient reported inability to void requiring urological intervention. T-test, fisher′s exact test, cox regression model and Kaplan-Meier survival analysis were performed. RESULTS 290 men with PPSUI that underwent a TOS were identified. POUR was reported in 11.7% (34/290). 33 of these 34 patients had a radical prostatectomy and 1 had a radical cystoprostatectomy with an orthotopic neobladder. POUR was associated with a lower average BMI (25± 2 versus 28± 3, p<0.01). Age, diabetes, pelvic radiation, a prior or concurrent bladder neck contracture had no correlation with POUR. We identified no urodynamic parameters that could distinguish patients that develop POUR during preoperative evaluation. 67.6% (23/34) patients were taught and performed temporary clean intermittent catheterization (CIC), 29% (10/34) had a temporary indwelling foley placed. All patients resolved spontaneously with 85% (29/33) lasting 1-7 days and 12% (4/33) for 7-30 days. Figure 1 shows survival estimates of TOS failure in men who experienced short-term POUR versus those who did not (p=0.04). Those with POUR had better long term outcomes with a hazard ratio of 0.47 (95%CI 0.2- 1.0). None had permanent retention nor required surgical intervention such a sling release. CONCLUSIONS We feel that this information is valuable in that all cases resolved spontaneously thus allowing us to avoid surgical intervention in these cases. We propose the following algorithm outlined in Figure 2 for the management of POUR. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e625-e626 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Divya Ajay More articles by this author Bryce Allio More articles by this author Ramiro Madden-Fuentes More articles by this author Andrew Peterson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Postoperative appointments: which ones count?

Although postoperative complications in women undergoing reconstructive pelvic surgery (RPS) have been characterized, little is known regarding the timeline of these occurrences. We aimed to determine the timeframe after RPS during which the majority of complications occur, to assist with planning intervals between postoperative visits. Women undergoing RPS were identified through billing information. Demographic, surgical, and complications data were extracted from electronic medical records. The Pelvic Floor Complication scale is a surgical scale tailored to women undergoing RPS. It contains three subscales: intraoperative, immediately postoperative, and delayed complications. We applied this scale to each postoperative visit (at 2, 6, and 13weeks). 396 women underwent RPS and 125 patients had 179 complications, most of which (66%) were identified by the 2-week visit. Complications at the 2-week visit consisted of urinary tract infection (UTI; 46%), wound infection (10.0%), and urinary retention (9.4%). The majority of serious complications (venous thromboembolism [VTE], ileus, small bowel obstruction [SBO], readmission, and reoperation [1 incarcerated hernia and 1 sling release]) were diagnosed by 2weeks. One patient was readmitted for ileus at between 2 and 6weeks. At between 6 and 13weeks, 1 patient was readmitted with SBO; 1 VTE was diagnosed; and 1 required reoperation for a prolapsed fallopian tube. In contrast, two thirds of the complications seen at the 13-week visit were due to granulation tissue, suture erosion or mesh erosion. The majority of non-mesh-related complications occur within the first 2weeks after RPS, whereas mesh and suture complications are more likely to be identified at the 13-week visit.

Patient Satisfaction After Sling Revision for Voiding Dysfunction After Sling Placement.

The aim of this study was to evaluate patient-reported outcomes after sling release for obstructive voiding after sling operation for female stress urinary incontinence. All female patients who had sling release for obstructive voiding at Mayo Clinic in Rochester, Minnesota, from January 1, 2000, through October 31, 2008, were identified and mailed a survey including validated questions for voiding symptoms. A composite outcome for surgical success was chosen in which participants reported global improvement (at least "much better") and complete satisfaction on a 7-point Likert scale. Logistic regression analysis was used to identify clinical and surgical predictors of this outcome. In total, 101 women were identified, of which 98 were alive at the time of mailing, and 55 women (56.1%) responded to the survey. Surgery before sling release was a synthetic midurethal sling in 62 patients and biologic sling in 39 patients. Clinical characteristics among mailing responders and nonresponders were similar aside from time from revision surgery to survey (median, 38.8 vs 54.6 months; P = 0.05). Overall, 23 (41.8%) of the 55 responding patients met the predefined criteria for surgical success. Multivariable analysis identified age younger than 60 years (odds ratio [OR], 4.22; P = 0.02), absence of overactive bladder symptoms before sling release (OR, 3.99; P = 0.04), and type of sling release (sling incision or loosening vs partial or complete excision) (OR, 3.78; P = 0.05) as predictors of success. Of responders, 23 (41.8%) reported global improvement and satisfaction. Younger age, lack of documented overactive bladder symptoms before sling release, and performing sling release with sling incision or loosening rather than partial or complete excision were associated with better satisfaction and patient-reported improvement.

Autologous Transobturator Urethral Sling Placement for Female Stress Urinary Incontinence: Short-term Outcomes

To evaluate short-term outcomes of autologous transobturator (ATO) urethral sling placement using rectus fascia for female stress urinary incontinence. We evaluated the outcomes of 33 consecutive females who underwent ATO sling placement with rectus fascia for stress incontinence from 2013 to 2014. Patients were seen at 3 months postoperatively and mailed a questionnaire at least 1 year after surgery for further follow-up. Outcomes were measured by the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) score and compared between pre- and postoperative responses using Wilcoxon signed-rank test. Retreatment-free survival rates were evaluated via Kaplan-Meier method. Median patient age was 62 years old (interquartile range [IQR] 47.5; 70.5) with a median body mass index of 28.6 kg/m(2) (IQR 24.7 kg/m(2); 32.4 kg/m(2)). When isolated sling placement was performed, 88% (15/17) were outpatient procedures. Median follow-up was 14.9 months (IQR 3.6; 18.7), during which 5 patients underwent repeat anti-incontinence surgery. For those without retreatment, 25/28 (89%) completed ICIQ-FLUTS at last follow-up. Compared to preoperative scores, patients who completed ICIQ-FLUTS questionnaires at 1 year or greater (N = 18) showed significant improvement in all domains: frequency (P = .007), voiding (P = .02), and incontinence (P = .004), and in quality of life related to frequency (P = .008), voiding (P = .002) and incontinence (P = .01). Among those who completed questionnaires both at 3 months and at least 1 year after surgery (N = 17), there was no significant deterioration in ICIQ-FLUTS scores. Overall retreatment-free survival rate was 92% at 1 year. Notably, no patients suffered severe (Clavien III-V) complications or required sling release. ATO urethral sling placement appears safe, with promising short-term outcomes. Longer follow-up and external validation are needed.

The effect of time to release of an obstructing synthetic mid‐urethral sling on repeat surgery for stress urinary incontinence

The primary objectives were to describe the rate of repeat surgery for stress urinary incontinence (SUI) after release of an obstructing synthetic mid-urethral sling (MUS) and to evaluate the effect of time from sling placement to sling release on repeat surgery rates. The secondary objective was to assess rates of recurrent and persistent SUI. This is a retrospective review of women who underwent synthetic MUS release (incision or excision of segment of sling) from 2005-2013. SUI rates and repeat surgery were ascertained by patient report and urinary distress inventory (UDI-6) questionnaire responses. Data analysis included descriptive statistics and multivariable logistic regression analysis. 107 patients were included. Median time to sling release was 22 months (IQR 5-49 months). 43.2% were transobturator slings. 15/107 patients (14%) underwent repeat surgery for SUI. On multivariable analysis, women were significantly less likely to undergo repeat surgery for SUI when sling release was performed >24 months after initial sling surgery (OR 0.12, 95% CI 0.02-0.85, P = 0.03) compared to release within 3 months. 49% and 77% reported recurrent and persistent SUI after sling release, of which 83% were significantly bothered. The repeat surgery rate for SUI was 14%. The rate of recurrent SUI was 49%. Most of these women were significantly bothered. On multivariate analysis, longer interval to sling release was associated with decreased likelihood of repeat surgery for SUI. The reason for a low repeat surgery rate for SUI despite a high rate of bothersome SUI should be explored in future studies. Neurourol. Urodynam. 36:349-353, 2017. © 2015 Wiley Periodicals, Inc.

66 Long term functional results after unilateral mid-urethral sling release for voiding dysfunction

66 Long term functional results after unilateral mid-urethral sling release for voiding dysfunction

Arthroscopic Treatment for External Snapping Hip

PurposeThe purpose of this study was to evaluate the clinical outcome of arthroscopic treatment for recalcitrant external snapping hip.Materials and MethodsBetween September 2011 and June 2013, we evaluated 7 patients (10 cases) with snapping hip who were refractory to conservative treatments for at least 3 months. Two patients (4 cases) were impossible to adduct both knees in 90°of hip flexion. Surgery was done in lateral decubitus position, under spinal anesthesia. We made 2 arthroscopic portals to operate the patients, and used cross-cutting with flap resection technique to treat the lesion. We performed additional gluteal sling release in those 2 patients (4 cases) with adduction difficulty. Average follow-up length was 19 months (range, 12-33 months). Clinical improvement was evaluated with visual analog scale (VAS), modified Harris hip score (mHHS), and also investigated for presence of limping or other complications as well.ResultsThe VAS decreased from 6.8 (range, 6-9) preoperatively to 0.2 (range, 0-2) postoperatively, and the mHHS improved from 68.2 to 94.8 after surgery. None of the patients complained of post-operative wound problem or surgical complications.ConclusionThe clinical outcome of arthroscopic treatment for recalcitrant external snapping hip was encouraging and all patients were also satisfied with the cosmetic results.

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

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 ...

Risk of Repeat Anti-Incontinence Surgery Following Sling Release: A Review of 93 Cases

Sling procedures are the most common surgery for stress urinary incontinence in women. Lower urinary tract symptoms are well documented complications of these procedures that develop in 5% to 20% of patients. A common treatment for postoperative urinary retention and bothersome obstructive voiding symptoms after anti-incontinence surgery is sling release. While previous studies indicated the risk of recurrent stress urinary incontinence after surgical release of slings, there is a paucity of data on how many patients require repeat anti-incontinence procedures. After receiving institutional review board approval we retrospectively reviewed the records of 143 consecutive female sling release procedures performed by 2 subspecialized urologists at our clinic from January 2000 through August 2012. A total of 121 patients underwent documented followup at our clinic, of whom 93 were treated with sling release for obstruction or retention after sling placement. We identified the characteristics of this patient population, specifically the incidence of subsequent anti-incontinence procedures. Mean ± SD patient age was 58 ± 13.2 years and median patient followup after surgical sling release was 32 months (IQR 6, 67). Of the 93 patients 13 (14%) required a repeat anti-incontinence procedure after sling release at a median of 3 months. Sling release remains an important treatment option in patients with obstruction after anti-incontinence surgery. Only a small percent of patients require repeat anti-incontinence surgery for recurrent stress urinary incontinence.

Transvaginal Sling Release With Intraoperative Ultrasound Guidance

Visualization of a midurethral sling may be challenging intraoperatively, especially if the sling is deep, well healed, not in the usual location, or made of materials that are not colored. We present the case of a 71-year-old woman presenting with a history of incomplete bladder emptying and debilitating voiding dysfunction documented by uroflowmetry and postvoid residual after a tension-free vaginal tape placement. Medications in addition to attempts to dilate her urethra failed to provide her with adequate relief. Intraoperative 3-dimensional ultrasound guidance was used to transect the sling that was otherwise unable to be localized with examination alone. Surgical transection of a tension-free vaginal tape can be safely performed under the guidance of ultrasound. At her 12-month follow-up visit, the patient did not have urinary incontinence or voiding dysfunction.

Revisions of Mid Urethral Slings Can be Accomplished in the Office

Mid urethral slings occasionally require revision for obstructive voiding symptoms or vaginal extrusion. Our approach has been to offer revision in office or resection done under local anesthesia when the patient is agreeable and deemed an appropriate candidate. The results and complications of these procedures are presented. We retrospectively reviewed the charts of patients from January 2003 to October 2010 to determine the subset with mid urethral sling insertion who subsequently underwent revision in the office or operating room, as identified through the Northwestern Medical Enterprise Data Warehouse. The CPT code for female sling insertion (57288) or revision/removal (57287) was used. A total of 41 revisions were performed in 28 of the 118 patients (23.7%) who underwent synthetic sling insertion. Reasons for adjustment were an intravesical sling (1 operating room case), extruded vaginal mesh (7 operating room and 19 office) and obstructive voiding symptoms (7 operating room and 7 office). Obstructive voiding symptoms in 6 of 7 operating room and 6 of 7 office patients improved immediately after sling release. There were no complications in either group but 3 office patients required repeat revision in the operating room due to inability to tolerate the procedure in 2 and to nonrelief of symptoms in 1. A total of 13 operating room adjustments were made according to surgeon preference while 2 patients elected the operating room, although adjustment in office was offered. Sling adjustment due to vaginal mesh extrusion or obstructive voiding symptoms can be successfully performed in the office with good result. When greater adjustment is needed, the operating room may be preferable. Surgeons should make these decisions based on their comfort level and patient preference.

Experience with TVT-SECUR sling for stress urinary incontinence: a 141-case analysis

The objective of this study was to investigate complications, urinary incontinence symptoms, and overall satisfaction in patients undergoing the tension-free vaginal tape-SECUR (TVT-S) for stress urinary incontinence (SUI). We reviewed consecutive patients treated with TVT-S between April, 2006 and August, 2007, in a urogynecology practice. Outcomes assessed included complications, voiding function, change in SUI symptoms on the Medical Epidemiological and Social Aspects of Aging (MESA) questionnaire, and overall satisfaction. One hundred forty-one women (age, 54.1 +/- 12 years; BMI, 31.2 +/- 6.6 kg/m(2)) were treated for SUI with the TVT-S; 34 required concomitant procedures. There were no intra-operative complications. Immediate post-operative voiding function returned in all but one patient; none required sling release. Most patients (90%) reported no pain on a verbal pain scale. On follow-up, 117 patients denied SUI symptoms, 16 reported mild symptoms, and eight required additional treatment. The average MESA "stress" subscore decreased by 79% (13.0 +/- 7.8 points, p < 0.0001). Eighty-five percent felt "satisfied" with the procedure. TVT-S is a safe and effective treatment for SUI.

Tratamiento quirúrgico de la incontinencia urinaria de esfuerzo mediante cabestrillo suburetral SPARC. Análisis de nuestra experiencia

IntroductionStress urinary incontinence (SUI) has a high incidence and important morbidity. Multiple surgical techniques have been described to treat it, with despair results. Suburethral slings have become, in recent years, a simpler and less invasive method to treat SUI surgically. Material and methodThe purpose of this paper is to review, retrospectively, 86 patients treated at our institution, from 10/01 to 12/05 of SUI, with a suprapubic suburethral sling (SPARC). ResultsMedium (range) age is 58.7 (39-80), hospital stay was 2.43 d (1-8) and catheter was removed 1.52 d (1-10). 14.5% of patients underwent other vaginal surgeries at same time, most frequently anterior colpoperineoplasty (10.7%). Complications are not very frequent; bladder perforation (5.8%), acute urinary retention (7%), chronic urinary retention (3.5%) and UTI (15.3%). Sling release was performed in 3.5% of women with chronic urinary retention. Total continence was found in 71.4% of patients with 10.1 months medium follow up (1-32). De novo urge symptoms were found in 26.2% of women, with urge incontinence in 54.5% of them. (p < 0,002; OR 5.0 (IC 95% 1.75-14.28). ConclusionsSuprapubic suburethral SPARC sling is a simple method, with few complications and fast social recovery. Outcome can be measured soon, with a high continence rate. De novo urge symptoms are high and they worsen functional results. It is necessary longer follow-up to evaluate long term outcomes.

Success of Pubovaginal Sling in Patients With Stress Urinary Incontinence and Efficacy of Vaginal Sling Release in Patients With Post-Sling Voiding Dysfunction

ObjectiveTo assess the overall success of sling procedures and surgical sling release in achieving urinary continence and voiding function in women with stress urinary incontinence. MethodsWe reviewed the charts of 107 patients with stress urinary incontinence who had a two-team abdominal-vaginal fascial sling procedure performed between January 2000 and December 2003. Data reviewed included the patients’ medical history, demographic data, findings on physical examination, urodynamic studies, operative report, and findings at visits 6 weeks, 6 months, and 12 months after surgery. Patients with sling releases were followed up to assess pelvic organ prolapse, uroflowmetry, and post-void residual urine volume, and to complete the quality of life questionnaire IIQ-7. ResultsAt one year after pubovaginal sling surgery, 82.1% of patients were cured of stress urinary incontinence. The majority (85.1%) of patients did not develop postoperative voiding dysfunction. Only 5.6% of those who did develop postoperative voiding dysfunction required surgical sling release. Sling release resolved the post-sling voiding dysfunction in three out of five patients. ConclusionPubovaginal sling surgery is a highly successful strategy for the management of stress urinary incontinence and has a low rate of postoperative voiding dysfunction. Surgical sling release may resolve post-sling voiding dysfunction.

Treatment of stress incontinence with the SPARC sling: Intraoperative and early complications of 445 patients

Objectives To review our series of 445 patients to obtain safety and early outcome information regarding use of the SPARC mid-urethral sling. The SPARC mid-urethral sling is commonly used to treat stress urinary incontinence. The SPARC technique involves passage of the trocars from an initial suprapubic approach. Methods We retrospectively reviewed the charts of all SPARC slings performed from the first procedure in August 2001 through December 2003. The Urogenital Distress Inventory and Incontinence Impact Questionnaire short-form surveys were mailed to the patients. All SPARC procedures were performed on an outpatient basis unless the patient was undergoing a concurrent procedure. Results The average patient age was 60 years. Concurrent prolapse repair and/or hysterectomy were performed in 97 patients (22%). The mean time from surgery to questionnaire response was 15 months. Ninety-one percent would undergo the procedure again, and 84% would recommend the SPARC to a friend. One patient was admitted postoperatively for a rectus hematoma. Another presented after 3 days with abdominal pain resulting from a small bowel perforation. Sling release was performed in 19 patients (4.3%) because of large postvoid residual urine volume or obstructive voiding symptoms. Conclusions The SPARC mid-urethral sling is an effective outpatient surgical procedure to treat stress urinary incontinence.