Sling Surgery Research Articles

The Potential of Non-ablative Erbium (YAG) Laser Treatment for Complications After Midurethral Sling Surgery: A Narrative Review.

Midurethral sling (MUS) surgery, using tension-free vaginal tape and transobturator tape, has been widely adopted for the treatment of stress urinary incontinence (SUI). However, postoperative complications, including persistent urinary incontinence, mesh exposure, and pain, have become problematic, and surgical treatments for these complications face challenges, such as invasiveness, treatment-resistant cases, and recurrence. This review provides an overview of the current evidence regarding these complications and the potential of vaginal non-ablative erbium (YAG) laser (VEL) treatment as a minimally invasive option with low risk of complications. Studies have suggested the effectiveness of VEL treatment, performed using devices such as IncontiLase (SP Dynamis; Fotona d.o.o., Ljubljana, Slovenia), for persistent urinary incontinence after MUS surgery, pain following mesh removal, and asymptomatic mesh exposure. VEL treatment is expected to be a new treatment option for complications following MUS surgery; however, further large-scale comparative trials are required to verify its efficacy and safety and to establish criteria for its indications. Appropriate assessment of the indications and provision of sufficient information to patients is important when presenting VEL as a treatment option.

Intra/inter-observer reliability of cystoscopic sphincter evaluation in men undergoing sling surgery.

To assess the intra/inter-observer reliability of cystoscopic sphincter evaluation (CSE) in men undergoing sling surgery for urinary incontinence and if possible to evaluate its correlation with the final clinical decision. Two expert urologists prospectively filmed and recorded, incontinent patient's cystoscopies according to a standard scenario. Anonymised recordings where randomly offered to the same observer twice. The observers (medical students, urology residents and full urologist with 0-5, 5-10, >10 years of practice, respectively) were asked to assess and score the recordings without knowing any of the patients' characteristics. In total, 37 recordings were scored twice by the 26 observers. The intraclass correlation coefficient (ICC) for intra-observer reliability of the CSE was 0.54 (moderate), 0.58 (moderate) and 0.60 (substantial) for medical students, residents, and urologists, respectively. However, when stratifying observers according to their experience, the lowest agreement values were found between experts with >10 years of experience. The inter-observer reliability for the CSE ICCs ranged between 0.31and 0.53, with the lowest ICC value observed between urologists (0.31). The study demonstrates poor intra- and inter-observer reliability of the CSE. According to these results, a CSE does not add valuable information to the clinical evaluation. In this scenario, it should not be considered in isolation from the patient's characteristics.

Assessment of Urinary Dysfunction After Midurethral Sling Placement: A Comparison of Two Voiding Trial Methods

Study objectiveTemporary urinary retention after midurethral sling (MUS) surgery requiring indwelling catheter or self-catheterization usage is common. Different methods for assessment of immediate postoperative urinary retention have been described. The aim of this study was to compare postoperative voiding trial (VT) success following active versus passive voiding trial in women undergoing MUS surgery.Design: Comparative retrospective cohort study. SettingFemale pelvic medicine and reconstructive surgery practice at a university affiliated tertiary medical center. PatientsPatients with stress urinary incontinence who underwent surgical treatment during the study period were eligible for inclusion. Excluded were patients under the age of 18, combined cases with other surgical services, planned laparotomy, patients with history of urinary retention and patients for whom their VT was performed on postoperative day 1. The cohort was divided into two groups: 1) patients who underwent an active retrofill of their bladder using a Foley catheter; 2) patients who were allowed to have a spontaneous void. Interventionsnone. Measurements and main resultsTwo hundred and eighty-five patients met the inclusion criteria for the study. Of these subjects, 94 underwent an active voiding trial and 191 underwent a passive voiding trial. There were no statistically significant differences in immediate postoperative urinary retention (30.8% vs. 29.3%, p=0.79) or time from surgery end to voiding trial (233.0 ± 167.6 minutes vs. 203.1 ± 147.8 minutes, p=0.13) between groups. Urinary retention, as defined by a failed voiding trial, increased from 10% to 29.3% when MUS placement was accompanied by concomitant prolapse repair procedure. Multivariate logistic regression analysis revealed that undergoing a combined anterior and posterior colporrhaphy (OR 5.13, p <0.001) as well as undergoing an apical prolapse procedure (OR 2.75, p=0.004) were independently associated with immediate postoperative urinary retention while increased BMI (OR 0.89, p<0.001) lowered likelihood of retention. ConclusionThe method used to assess immediate postoperative urinary retention did not affect VT success. Concomitant combined anterior and posterior colporrhaphy and apical suspension were correlated with greater likelihood of VT failure while increased BMI decreased odds of retention.

Simulated operations (SOs) apply mechanical support to structures to confirm symptom causation.

Simulated operations (SOs) are a direct application of the Integral Theory (IT) mantras, "structure and function are related" and "restore the structure and you will improve the function". SOs performed in a clinic setting, are the most effective way possible to test the validity of the IT predictions: stress urinary incontinence (SUI) and urge are mainly caused by laxity in the vagina or its supporting ligaments. The SUI prediction of the IT is validated if a hemostat applied vaginally in the position of the midurethra to mechanically support the pubourethral ligament (PUL) immediately stops urine loss on coughing. The urge and chronic pelvic pain (CPP) predictions of the IT are similarly validated if a patient states her urge and pain symptoms are relieved by insertion of the bottom blade of a bivalve speculum which supports the uterosacral ligaments (USLs). An important use of SOs is to preoperatively assess (by the hemostat test) whether sling surgery for SUI is likely to cure the patient. Similarly, the speculum is very useful for diagnosing whether severe urge or pain symptoms in a woman with minimal prolapse are originating from weak USLs. If digital support of a cystocele relieves urge symptoms, the patient can reasonably be informed that a cystocele repair should improve the urge as well her cystocele prolapse. Used intraoperatively under spinal anesthesia, SOs can determine whether a sling is sufficiently tight to reverse the loose PUL which is causing the SUI. Approximating both cardinal ligaments (CLs) intraoperatively can result in a remarkable disappearance of a transverese defect cystocele; approximating USLs intraoperatively can give an indication of how effective a USL plication would be surgically.

Порівняння функціональних результатів і якості життя після хірургічного лікування стресового нетримання сечі в жінок

Sling surgery is a modern and effective surgical treatment for stress urinary incontinence in women. However, there is insufficient data on the comparative analysis of long-term results and quality of life of patients after various options of such operations. Purpose - to compare the functional results and quality of life of women after two variants of sling operations for stress urinary incontinence. Materials and methods. 84 women with stress urinary incontinence were examined, who were divided into two groups. In the Group I, a plastic free synthetic loop (TVT) was performed, in the Group II - an operation using the transobturator location of the prolene loop (TVT-Obturator - TVT-О). Functional outcomes of treatment and quality of life were assessed 2 years after surgery using the ICIQ-SF questionnaire, the Patient General Impression of Improvement (PGI-I) scale, and the Patient Satisfaction Scale. An objective indicator was the absence of leakage of urine during a cough test. Results. Treatment effectiveness, according to objective criteria, was 87.9% and 67.9% 2 years after TVT and TVT-O surgery, respectively (p=0.045). When evaluating subjective indicators, no statistically significant differences between groups were found, however, according to the ICIQ-SF questionnaire, the frequency of improvement in the quality of life was reliably 1.3 times higher in the case of using the TVT technique (odds ratio 3.33; 95% confidence interval 1.14-9.78). The frequency of urinary incontinence recurrence did not depend on the method of sling operation (p&gt;0.05). Data analysis was carried out using The Statistical Package for Social Sciences. Conclusions. When evaluating the results of treatment 2 years after the intervention, the effectiveness of TVT surgery, according to objective criteria, is statistically significantly higher than the effectiveness of TVT-O surgery, although the latter technique is associated with the absence of bladder etching. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Autologous rectus abdominis fascia sling surgery following unsuccessful synthetic midurethral sling

IntroductionWe performed autologous rectus abdominis fascia sling surgery using Advantage™ following an unsuccessful synthetic midurethral sling.Case presentationAt the age of 76 years, the patient experienced stress urinary incontinence recurrence. A 1‐h pad test resulted in 259 g of leakage. A pressure flow study verified urine leakage while coughing and straining without detrusor overactivity. Abdominal leak point pressure was 10 cmH2O. Autologous rectus abdominis fascia sling surgery was performed using Advantage™. One month postoperatively, a 1‐h pad test resulted in 0 g of leakage.ConclusionWe believe that this method will allow the fascia sling procedure to be performed reliably even if one is unfamiliar with conventional autologous rectus abdominis fascia sling surgery.

Mid- to long-term results of Polyacrylamide Hydrogel (Bulkamid®) as recourse for female stress urinary incontinence

Aim:We aimed to assess the mid- to long-term outcome of Polyacrylamide Hydrogel urethral injections as a treatment for women with stress urinary incontinence (SUI), who are not eligible for treatment with midurethral slings. Methods:We performed a single-arm, patient cohort study using the subjective improvement rate as primary outcome, defined as an answer “(very) much better” on the Patient Global Impression of Improvement. Secondary outcomes were the subjective cure rate (a negative answer to the Urogenital Distress Inventory stress subscale question 4), patient satisfaction (Visual Analogue Scale of ≥ 8.0), complication rate, the amount of Hydrogel injected, the number of reinjections and to what extent patients would recommend this treatment. Results:A total of 357 women with pure SUI, or mixed urinary incontinence with predominant SUI were included. Adverse events were retrieved from their patient records and all received a questionnaire, which was completed and returned by 153 (42.9%) women. After a median follow-up of two and a half years, the subjective improvement rate was 52.1%. The subjective cure rate was 30.9%. A satisfaction score of ≥ 8.0 was achieved in 48.6% of the patient group. Minor adverse events due to the procedure were reported in 21% of patients. No serious adverse events were noted. Conclusions:This study demonstrates that Polyacrylamide Hydrogel, even after a mid- to long-term follow-up, is a valuable treatment option for women with SUI, who are ineligible for midurethral sling surgery. No serious adverse events related to the procedure were reported during the follow-up period.

Sling for the sling: a new technique for long-term correction of severe congenital ptosis

IntroductionSevere congenital ptosis poses a complex challenge for oculoplastic surgeons, requiring meticulous surgical intervention to restore eyelid function and improve aesthetic outcomes mainly by using frontalis sling approach. A crucial issue in frontalis sling surgeries is the sustainability of effect.PurposeThis retrospective study reports the outcomes of two surgical techniques for treating severe congenital ptosis in the paediatric age group: Silicon rods ptosis sling and a novel technique involving the use of Silicon rods with green braided polyester (Ethibond) sutures to secure the rods in place “sling for the sling”.MethodsThe medical records of children who underwent frontalis suspension were reviewed in a retrospective fashion. We identified two groups; the first group (20 patients: 35 eyelids) had the traditional frontalis suspension surgery using silicone suspension set, the second group (14 patients: 25 eyelids) was operated using the new “sling for sling” technique. We used the postoperative marginal reflex distance-1 (MRD-1) as the primary outcome measure while the frequency of both wound related complications and recurrence were considered as secondary outcome measures. Post operative data were collected and compared after 1 month, 6 months, 12 months, and 18 months.ResultsPreliminary results indicate promising outcomes for both techniques, with significant improvement in eyelid elevation observed in both groups. However, the novel technique using Silicon rods with Ethibond sutures demonstrated enhanced sustainability, leading to a more durable outcome with significantly less recurrence.ConclusionThis study highlights the potential benefits of the novel technique in treating severe congenital ptosis and introduces an innovative approach to Silicone rods fixation to achieve a long-term corrective effect.

Effectiveness of onabotulinumtoxin A for refractory overactive bladder with cough‐associated detrusor overactivity

Effectiveness of onabotulinumtoxin A for refractory overactive bladder with cough‐associated detrusor overactivity

Postoperative Complications After Sling Operations for Incontinence: Is Race a Factor?

Racial and ethnic disparities exist in urogynecologic surgery; however, literature identifying specific disparities after sling operations for stress incontinence are limited. The objective of this study was to evaluate racial and ethnic disparities in surgical complications within 30 days of midurethral sling operations. This retrospective cohort study identified women who underwent an isolated midurethral sling operation between 2014 and 2021 using the American College of Surgeons National Surgical Quality Improvement Program database. Women were stratified by racial and ethnic category to assess the primary outcome, 30-day surgical complications, and the secondary outcome, comparison of urinary tract infections (UTIs). There were 20,066 patients included. Mean age and body mass index were 53.9 years and 30.8, respectively. More Black or African American women had diabetes and hypertension, and more American Indian or Alaska Native women used tobacco. The only difference in 30-day complications was stroke/cerebrovascular accident, which occurred in only 1 Asian, Native Hawaiian or other Pacific Islander patient (0.1%, P < 0.0001). The most frequent complication was UTI (3.3%). Black or African American women were significantly less likely to have a diagnosis of UTI than non-Hispanic White (P = 0.04), Hispanic White (P = 0.03), and American Indian or Alaska Native women (P = 0.04). Surgical complications within 30 days of sling operations are rare. No clinically significant racial and ethnic differences in serious complications were observed. Urinary tract infection diagnoses were lower among Black or African American women than in non-Hispanic White, Hispanic White, and American Indian or Alaska Native women despite a greater comorbidity burden. No known biologic reason exists to explain lower UTI rates in this population; therefore, this finding may represent a disparity in diagnosis and treatment.

Comparison of perioperative adverse events following suburethral sling placement using synthetic mesh, autologous rectus fascia, and autologous fascia lata in a national surgical registry.

To assess and compare 30-day perioperative adverse events following suburethral sling surgery using synthetic mesh, autologous rectus fascia, and autologous fascia lata in women. This was a retrospective cohort study of patients who underwent fascial or synthetic sling placement for stress urinary incontinence between 2008 and 2021 using the American College of Surgeons' National Surgical Quality Improvement Program database. Current Procedural Terminology codes were used to identify patients undergoing each type of sling procedure. Multivariable regression analysis with stepwise regression was used to assess the odds of composite adverse events (e.g., urinary tract infection, surgical site infection, pulmonary embolism, and other reportable events) between cohorts. Of the 41 533 female patients who underwent isolated suburethral sling placement without concurrent procedures, 41 292 (99.4%) received a synthetic mesh sling, and 241 (0.6%) received an autologous facial sling. In the fascial sling cohort, 160 (66.4%) underwent rectus fascia harvest and 81 (33.6%) underwent fascia lata harvest. Sling surgeries involving autologous fascia were associated with increased odds of adverse events compared to those involving synthetic mesh, even after adjusting for confounders (adjusted odds ratio [aOR]: 3.63, 95% confidence interval [CI]: 2.56-5.15). Compared to fascial slings from rectus fascia, slings from fascia lata were associated with increased odds of composite adverse events (aOR: 2.11, 95% CI: 1.03-4.04). However, with the exclusion of urinary tract infections, the adverse event rate was similar between slings using the two fascial harvest techniques (aOR: 1.93, 95% CI: 0.81-4.63). In this retrospective database study, suburethral sling surgeries using autologous fascia were independently associated with a 3.6-fold increase in odds of 30-day perioperative adverse events compared to sling surgeries using synthetic mesh.

(211) Comparable Continence Rates Following Male Urethral Sling Surgery in “Standard” versus “Nonstandard” Patients

Abstract Introduction Transobturator male urethral slings are a surgical option for the management of stress urinary incontinence (SUI). Historically, patient continence and satisfaction rates are influenced by several variables, including: baseline incontinence severity, prior surgical interventions, and exposure to radiation. Ideal or “standard” patients for sling placement have mild or moderate incontinence and no prior incontinence procedures or radiation exposure. Standard patients have been proposed to have better postoperative continence and satisfaction rates than their “nonstandard” counterparts. Objective In this study we sought to compare the efficacy and complication rates of transobturator male sling placement between standard and nonstandard patients. Methods A retrospective, single-institution review was performed of all patients who underwent either an AdVance™ or an AdVanceXP™ sling insertion between October 2016 and May 2023. Patient demographics, preoperative and postoperative continence rates, and complication rates were collected. Patients were then stratified as “standard’ vs “nonstandard”. Standard patients were defined as having a history of radical prostatectomy (robotic or open) and no prior radiation or prior incontinence procedure. Nonstandard patients had prior history of transurethral resection of the prostate, simple prostatectomy, radical cystectomy, prior sling insertion, or prior radiation. The continence and complication rates were compared between groups. Continence was measured in pads per day (PPD). Improvement in continence was defined as a reduction of at least 50% in PPD at 6 weeks postoperatively. Baseline and postoperative PPD were tabulated with median and 25th-75th percentiles, then compared using Wilcoxon signed-rank test. Other variables were summarized with frequency and percentages, and compared using Fisher’s exact test. Results 62 patients were included in this study, of which 48 and 14 were standard and nonstandard, respectively. Mean age was 66 (52-85) years and body mass index (BMI) was 29 (20.3-39.8) kg/m2. No difference in baseline characteristics were noted between the groups (Table 1). 77% of patients had an improvement in SUI following sling placement: 38/48 (79%) patients in the standard group and 10/14 (71%) patients in the non standard group. The most common complication among both groups was urinary retention requiring catheterization (29%), which resolved spontaneously within two weeks in all patients. In the nonstandard group, one patient developed an abscess, one had a scrotal hematoma, and two patients had urinary tract infections (UTI). One patient with history of radiation developed a urethrocutaneous fistula requiring sling removal. There was no significant difference in overall complication rates between standard and nonstandard patients. Comparable rates of improvement in preoperative to postoperative SUI were noted: 2.5 to 0.8 PPD in the standard group and 3.3 to 1.0 PPD in the nonstandard group (Figure 1). Conclusions In this study, nonstandard and standard patients had similar continence and complication rates following urethral sling placement. Future prospective studies are warranted to assess the safety and long-term outcomes of standard and nonstandard patients. Disclosure No.

Orbital septum attachment site on the levator aponeurosis sling for mild congenital blepharoptosis

PurposeThis study aimed to investigate the value of the orbital septum attachment site on the levator aponeurosis (OSASLA) sling in correcting mild congenital blepharoptosis.MethodsA total of 60 patients (92 eyes) with mild congenital blepharoptosis (levator function ≥ 8 mm) were treated in our hospital from January to October 2021, and relevant data of these patients were collected. All patients underwent OSASLA sling for ptosis correction. The distances from the superior tarsal border to the OSASLA were measured. The primary outcome was the number of postoperative changes in the marginal reflex distance 1 (MRD1). Pearson’s correlation coefficient between the distance from the superior tarsal border to the OSASLA and the height of the upper eyelid elevated was analyzed.ResultsFifty-eight patients (89 eyes) successfully underwent OSASLA sling surgery. The preoperative MRD1 was 1.4–3.6 mm (mean 2.1 ± 0.5 mm), and the postoperative MRD1 was 3.4–5.0 mm (mean 3.7 ± 0.6 mm). The distance from the superior tarsal border to the OSASLA sling was significantly and positively correlated with the height of the upper eyelid elevation (r = 0.7328, P < 0.0001). The eyelid margin positions of the patients did not regress substantially during 6–18 months of follow-up.ConclusionsCompared with the shortening of levator palpebrae superioris (LPS) and pleating of LPS, the OSASLA sling is a less invasive, more effective, and easy-operating surgery for mild congenital blepharoptosis.

Midurethral sling position and surgical outcome: A meta-analysis.

There is still ongoing debate as to whether the outcome of the sling is determined by the position of the midurethral sling. In order to evaluate the potential impact of sling position on the outcomes of retropubic and transobturator sling procedures for stress urinary incontinence, it is necessary to conduct further investigations. We conducted a comprehensive search across various electronic databases such as PubMed, EMBASE, MEDLINE. Relevant data were extracted, organized in a table format, and analyzed using RevMan software for further analysis. This review comprised a total of 9 studies. The findings indicate that patients with TVT tape placement in the midurethra exhibited a slightly higher cure rate compared to those with proximal placement. Conversely, tape placement in the midurethra was associated with a significantly higher cure rate compared to distal placement [RR = 0.84, 95% CI (0.74-0.95), P < .05]. In the case of transobturator slings, tape positioning beneath the midurethra or distal urethra yielded better outcomes compared to placement near the bladder neck [RR = 0.74, 95% CI (0.57-0.94), P = .02; RR = 0.61, 95% CI (0.39-0.96), P = .03]. Based on 2D and 3D ultrasound imaging, differences in TVT placement appear to have minimal impact on the cure rate. However, the highest rate of failure after transobturator sling surgery is closely linked to the positioning.

Безопасность субуретральной петлевой пластики трансобтураторным доступом у пациенток младше 45 лет

Introduction. Symptoms of stress urinary incontinence develop with age in every third woman. To date, suburethral sling surgery is the «gold standard» treatment for stress urinary incontinence. Sling operation is possible by various approaches, each of them has its own advantages and disadvantages. It is believed that transobturator access is combined with the risks of damage of the obturator vessels, tendons of the adductor muscles of the thigh, branches of the genital and anterior labial nerves. In connection with the above, most authors do not recommend the transobturator access for younger patients. The purpose of the study. To evaluate the efficacy and safety of suburethral sling surgery by transobturator access in patients under 45 years of age suffering from stress and mixed forms of urinary incontinence. Materials and methods. A single-center, retrospective observational study was conducted. The anamnestic data of the patients, efficacy (according to the examination in the chair, questionnaires ICIQ-SF, IIQ-7) and safety (the presence of erosions of the synthetic prosthesis, dyspareunia and chronic pain by examination, survey and questionnaires VAS, ODI) were evaluated. The analysis of the obtained data was carried out using the Microsoft Excel data array processing program. Results. After applying the inclusion and exclusion criteria, 61 patients participated in the study. The subjective effectiveness of the operation was 98.3%, the objective effectiveness was 95%. No erosion of the synthetic prosthetic device was observed in any patient. Chronic pain persisting for more than 1 month was noted in 1 patient (1.7%). Complaints of dyspareunia were also noted in only 1 patient (1.7%). Conclusion. The obtained results indicate the high efficiency and safety of transobturator access, and allow us to conclude that the use of transobturator access as a technique for primary implantation of a suburethral sling in young patients is justified.

Frontal Sling and Levator Resection Surgery for Ptosis Due to Third Cranial Nerve Paralysis

Frontal Sling and Levator Resection Surgery for Ptosis Due to Third Cranial Nerve Paralysis

Increased Rate of Mesh Erosion in Breast Cancer Survivors Taking Antiestrogen Therapy.

There are no current data investigating the relationship between mesh-exposure complications after midurethral sling surgery and antiestrogen therapy. We sought to determine if there are increased mesh-exposure complications between a breast cancer population versus a noncancer population particularly in conjunction with hormone suppression (HS) therapy. A retrospective chart review was performed on patients with a history of breast cancer undergoing tension-free vaginal tape (TVT) surgery at our institution between 2013 and 2021. A group of patients who underwent TVT surgery without a history of cancer served as our control. Univariate and multivariate logistic regression analyses were performed to identify predictors of mesh exposure complications. One hundred twenty-one patients with breast cancer had TVT surgery. Two hundred ninety-seven patients without cancer had TVT surgery during the same period. Baseline characteristics across all groups were similar. Twenty-nine patients (6.9%) experienced mesh exposure. This occurred at a higher rate in our cancer (15.7%) versus the noncancer population (3.4%). Women with breast cancer taking HS therapy had a higher rate of mesh exposure complications compared with those not taking HS therapy (25.0% versus 6.6%; P = 0.005). The highest rate of mesh exposure complications occurred in the cohort taking estrogen receptor modulators, selective estrogen receptor modulator (10/36 [27.8%]) versus aromatase inhibitors (5/24 [20.8%]) versus no HS therapy (4/61 [6.6%]; P = 0.014). On multivariate analysis, HS therapy use (odds ratio, 1.57; P = 0.007) and diabetes mellitus (odds ratio, 4.53; P = 0.018) were associated with increased TVT-related complications. Women with breast cancer had a higher rate of mesh exposure complications from TVT surgery compared with women without cancer, particularly those taking antiestrogenic therapy.

Comparison of Stab Incision and Eyelid Crease Incision Techniques in Children with Revision Frontalis Sling Surgeries Using Silicone Rods.

To compare stab and eyelid crease incision techniques in revision frontalis sling surgeries using silicone rods. This retrospective study involved 52 eyes in 48 consecutive pediatric patients who underwent revision frontalis sling surgery between 2008 and 2019. All primary surgeries were performed by making eyelid crease incisions and suturing of silicone rods onto the tarsal plates. The revision surgeries were performed by either making stab incisions over the eyelid through which to pass the silicone rods (group A), or by refixing the same or a new silicone rod to the tarsal plate (group B). The surgical results were compared. The mean follow-up period was 22.4 months (range, 6-62 months) and the mean age of the patients was 6.1 years (range, 1-16 years). There were 28 female and 20 male patients. Surgical success was achieved in 23 of 28 patients (82.1%) in group A, and 12 of 24 patients (50.0%) in group B. The difference between the groups was statistically significant (p = 0.012). Superficial punctate epithelial defects were detected in six group A patients (21.4%) and seven group B patients (29.1%). In group B, lid hematoma occurred in three patients (12.5%) and entropion occurred in three patients (12.5%). The silicone rods were removed from two eyes, and entropion spontaneously resolved in one eye with close follow-up. Using the stab incision technique increases revision frontalis sling surgery success rates when primary surgeries are performed using eyelid crease incisions and suturing silicone rods to the tarsal plates in children.

Risk factors for 5-year complications after midurethral sling surgery for stress urinary incontinence: a retrospective cohort study from Taiwan

Midurethral sling surgery is the current gold standard worldwide for stress urinary incontinence (SUI) surgery, with over 90% of surgeons worldwide using the midurethral sling for SUI between 2008 and 2018. However, concerns surround mesh-related adverse events associated with the midurethral sling. The decision to use the midurethral sling for surgical treatment has become a challenging one for clinicians, surgeons and patients. We sought to determine the factors for 5-year complications after midurethral sling surgery, to improve the clinical decision-making process. Records were reviewed from a total of 1961 female patients who underwent their first midurethral sling surgery for SUI between 2003 and 2018 at a single teaching hospital in Taiwan. A multivariable Cox proportional hazard model calculated the hazard ratios of risk factors for surgical complications, after adjusting for confounders. Surgical complications (i.e., secondary surgery and urinary retention) occurred in 93 (4.7%) patients within 5 years following the index operations. These patients were more likely to be older, to have a history of menopausal syndrome within 1 year prior to the index operation, a medication history of oral antidiabetic drug use, hormone replacement therapy (HRT), slower average flow rate, and longer voiding time compared with patients without surgical complications. In the multivariate analysis, HRT (adjusted hazard ratio, 1.787; 95% confidence interval, 1.011–3.158, p = 0.04) was significantly associated with surgical complications at 5 years, after adjusting for age, gender, diabetes, menopause syndrome, average flow rate, and sling type. Our findings suggest that a medication history of HRT may be a risk factor associated with surgical complications, especially urinary retention, at 5 years in women undergoing midurethral sling surgery for SUI.

Second Suburethral Sling Implantation for the Recurrent Urinary Incontinence after Radical Prostatectomy when First Sling Surgery was Non-Effective: Case Report

Stress urinary incontinence is a complication after radical prostatectomy. The suburethral sling implantation operation is often performed for mild to moderate male urinary incontinence after radical prostatectomy. There are non-adjustable suburethral slings that are effective up to 73.7% and adjustable slings that are effective up to 92%. We present a case report of a 62-year-old man who underwent radical prostatectomy due to prostate cancer in 2018 and experienced moderate degree urinary incontinence. After non-effective conservative treatment in 2020-02-27, the suburethral transobturator sling implantation was performed in another hospital, but it did not yield effective results. After further examinations in 2023-03-25, an adjustable ATOMS system suburethral male sling implantation was performed and it was effective. 2023-05-03 ATOMS system was adjusted and after this there was no urinary incontinence. ATOMS system is an effective surgical method for the treatment of male recurrent urinary incontinence or for cases where the initial sling implantation has failed.