Urethral Sling Research Articles

Quality of Pre-operative Assessment for Mid Urethral Slings in Women Who Present With Mesh Complications

ObjectiveTo study quality of pre- and post-operative evaluation in women undergoing mid-urethral synthetic sling surgery who subsequently have complications. Materials and methodsStudy inclusion was chart availability for preoperative clinical history, examination, urodynamics and/or post-operative visit in women with mesh complications 2014-2021 in a tertiary practice. The primary outcome was compliance with quality indicators and guidelines for preoperative and post-operative clinical evaluation and urodynamics. Results122 women had preoperative, 102 urodynamic reports and 108 post-operative charts available for review. Only clinical history and examination showed moderate compliance (71% nature, 57% severity, 87% exam) with quality indicators, all other quality indicators were low. including documentation of counselling of mesh risks (11%) and risks of incontinence surgery (17%) . Compliance with guidelines (optimal care) was also low (bladder diary 61%, all others ≤41%). Post-operative evaluation did not comprehensively screen for complication e.g., flow rate/post-void residual performed in 9%. A significant proportion had an early adverse symptom (55%) or intervention e.g. trimming of exposure (40%) ConclusionCompliance with quality indicators and guidelines was generally low for pre-operative evaluation and urodynamic testing. There was inadequate content and length of post-operative evaluation despite a significant proportion presenting with adverse symptoms at first postoperative follow-up. Future research could target these areas for development of tools to improve compliance and education of health providers.

Would Surgeons Opt for Polypropylene Mesh if They Hypothetically Had Stress Urinary Incontinence or Pelvic Organ Prolapse?

Mesh is routinely used to treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP). However, its use remains controversial. The FDA (U.S. Food and Drug Administration) ultimately deemed mesh use for SUI and transabdominal POP repair acceptable, while cautioning against transvaginal mesh for POP repair. The objective of this study was to evaluate personal opinions regarding mesh use among clinicians who routinely treat POP and SUI if they themselves were to hypothetically have either condition. A nonvalidated survey was sent to the Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) members, and American Urogynecologic Society (AUGS) members. The questionnaire asked participants if they were to hypothetically have SUI/POP which treatment they would elect. A total of 141 participants completed the survey (20% response rate). A significant proportion preferred synthetic mid urethral slings (MUS) for SUI (69%, p <0.001). Surgeon volume was significantly associated with MUS preference for SUI in both univariate and multivariate analyses (OR 3.21 and 3.67, p <0.003). A significant proportion of providers preferred transabdominal repair or native tissue repair for POP (27% and 34% respectively, p <0.001). Private practice was significantly associated with transvaginal mesh preference for POP in univariate analysis but not multivariate analysis (OR 3.45, p <0.04). The use of mesh for SUI and POP has been controversial, leading to the FDA, SUFU and AUGS statements on synthetic mesh use. Our study found that the majority of SUFU and AUGS members who regularly perform these surgeries prefer MUS for SUI. Preferences regarding POP treatments varied.

Impact of treatment with sling placement for stress urinary incontinence on quality of life: case report and literature review

Introduction: urinary incontinence is defined as a condition of involuntary leakage of urine. Although minimal, incontinence is associated with a significant decline in quality of life, social, professional, and mental health, as well as sexual dysfunction in these women. Objective: To report the impact of sling used on the long-term quality of life of a patient with stress urinary incontinence. Case Report: 37-year-old patient without comorbidities, five pregnancies, three natural deliveries, one cesarean section, and one abortion, with an interval between deliveries of approximately one year. She began to experience mild urinary incontinence at medium and heavy exertion (cycling, climbing stairs quickly, carrying weight) or in near-maximum bladder capacity, in drips, with progressive worsening of symptoms over time that negatively impacted her quality of life. After several outpatient evaluations and with the persistence of symptoms, the patient underwent insertion of a mid-urethral sling. Conclusion: the use of a urethral sling had a positive impact on the control of incontinence and improvement in the long-term quality of life of a young patient with stress urinary incontinence.

Efficacy of a synthetic middle urethral sling in patients with mixed urinary incontinence

Introduction. Mixed urinary incontinence is believed to be more difficult to treat than stress urinary incontinence and overactive bladder (OAB) alone. However, the mixed form occurs in one in three women with complaints of incontinence. Therefore, the evaluation of the effectiveness of the transobturator suburethral sling in patients with a mixed form of urinary incontinence is a topical issue.Objective. To evaluate the efficacy of the transobturator suburethral sling in patients with mixed urinary incontinence.Materials and methods. The cohort study enrolled 106 patients with a mixed form of urinary incontinence. Validated questionnaires (Overactive bladder questionnaire/OABq, Urinary Distress Inventory, Short Form/UDI-6) were used to assess subjective data. Secondary endpoint – objective data of comprehensive urodynamic study 2 – 12 months after transobturator suburethral sling implantation: presence of phase, terminal, constrictor-induced detrusor overactivity (DOA).Results. According to the preoperative evaluation of complaints on validated questionnaires, the mean UDI-6 score was 52.2 ± 16.3 points, OABq was 15.4 ± 5.4 points. After surgery, there was a decrease in the UDI-6 questionnaire scores to 19.4 ± 18.4 scores and OABq to 9.6 ± 4.1 scores, the difference for both of which was statistically significant (p &lt; 0.001). Terminal DOA was sighted in 44 (41.5%) preoperative patients and 33 (31.1%) postoperative patients (p = 0.153). Stress-induced DOA was observed in 27 (25.5%) before and 6 (5.7%) after surgery (p &lt; 0.001), respectively. Seventy-two (67.9%) patients reported satisfaction with the surgery and willingness to recommend it to their friends. For 26 (24.5%) patients, the surgery had no significant effect on quality of life. Eight (7.5%) patients noted a worsening of symptoms after treatment. No effect of sling installation on the course of OAB was found.Conclusion. The placement of a synthetic suburethral sling has improved the quality of life in many patients with a mixed form of urinary incontinence.

This Month in Adult Urology

This Month in Adult Urology

54 - Detrusor hyperactivity with impaired contractility: Prevalence and impact on middle urethral sling outcomes

54 - Detrusor hyperactivity with impaired contractility: Prevalence and impact on middle urethral sling outcomes

68 - Large urethral erosion in women who underwent middle urethral sling: Outcomes of surgical repair

68 - Large urethral erosion in women who underwent middle urethral sling: Outcomes of surgical repair

PD34-07 PREDICTORS OF SLINGS AFTER URETHRAL DIVERTICULECTOMY: A 5-YEAR LARGE POPULATION ANALYSIS

You have accessJournal of UrologyCME1 May 2022PD34-07 PREDICTORS OF SLINGS AFTER URETHRAL DIVERTICULECTOMY: A 5-YEAR LARGE POPULATION ANALYSIS Allison Sih, Seth Cohen, Fornati Bedell, Karyn Eilber, Victoria Scott, and Kai Dallas Allison SihAllison Sih More articles by this author , Seth CohenSeth Cohen More articles by this author , Fornati BedellFornati Bedell More articles by this author , Karyn EilberKaryn Eilber More articles by this author , Victoria ScottVictoria Scott More articles by this author , and Kai DallasKai Dallas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002585.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of female urethral diverticula can be challenging and can result in stress urinary incontinence (SUI). Currently there is no consensus on management strategy to perform placement of a urethral sling concomitantly or at a delayed interval. In efforts to further elucidate this, we aimed to characterize those patients who went on to further surgical intervention for SUI after urethral diverticulectomy. METHODS: All women undergoing urethral diverticulectomy in California between January 2013 through December 2018 were identified using the Office of Statewide Health Planning and Development data sets (CPT 53230). Women who underwent a urethral sling procedure for SUI, either autologous fascial or synthetic, were identified from this cohort (CPT 57288). Women who had undergone concomitant sling at time of urethral diverticulectomy were excluded. Patient demographics such as age, race/ethnicity, payor type and comorbidities (diabetes mellitus, hypertension, obesity) were identified. Univariate (t-test and chi-square test) and multivariate analysis (multivariable logistic regression) were performed among the patient factors above and the risk of a future sling procedure. RESULTS: A total of 525 women (mean age 47.2 years) underwent a urethral diverticulectomy during this time period. Of these, 43 (8.2%) underwent a subsequent urethral sling. Limiting the analysis to women who had at least two years of follow up after diverticulectomy, this rate increased to 12.2%. Women of older age (51.6 vs. 41.9, p<0.001), and women with obesity (14.9% vs. 7.1%, p=0.024) were more likely to undergo a subsequent sling procedure. These effects were significant under multivariate analysis, controlling for all other factors. There was no significant effect of patient race or payor status on rates of subsequent sling procedure. CONCLUSIONS: The rate of SUI after treatment of urethral diverticulum for which patients subsequently underwent a urethral sling procedure is not insignificant (12.2% in those with at least two years of follow up). Given that some women with SUI will not elect for surgical intervention, this suggests that an even higher number of women have bothersome incontinence. Women of older age or with obesity have a higher rate of SUI necessitating surgical treatment. Consideration of these factors for sling placement at the time of urethral diverticulum repair may avoid secondary procedures. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e562 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Allison Sih More articles by this author Seth Cohen More articles by this author Fornati Bedell More articles by this author Karyn Eilber More articles by this author Victoria Scott More articles by this author Kai Dallas More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP52-16 ELUCIDATION OF URINARY INCONTINENCE MECHANISM AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY FOCUSING ON THE SLING MECHANISM BY THE LEVATOR ANI MUSCLE

You have accessJournal of UrologyCME1 May 2022MP52-16 ELUCIDATION OF URINARY INCONTINENCE MECHANISM AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY FOCUSING ON THE SLING MECHANISM BY THE LEVATOR ANI MUSCLE Masao Kataoka, Tomoyuki Koguchi, Junya Sato, Yuichi Sato, Hidenori Akaihata, and Yoshiyuki Kojima Masao KataokaMasao Kataoka More articles by this author , Tomoyuki KoguchiTomoyuki Koguchi More articles by this author , Junya SatoJunya Sato More articles by this author , Yuichi SatoYuichi Sato More articles by this author , Hidenori AkaihataHidenori Akaihata More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002627.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this study was to clarify the mechanism of urinary incontinence after robot-assisted radical prostatectomy (RARP) focusing on changes in the pelvic floor muscles and function of sling mechanism. METHODS: A total of 323 patients underwent RARP in our hospital from 2014 to 2019 were included and retrospectively analyzed. All patients were analyzed levator ani muscles, especially puborectalis muscle (PRM) and rectourethral muscle (RUM) by preoperative and postoperative MRI. The movement of the levator ani muscle was analyzed by postoperative cine MRI. One-hour pad test was underwent 1, 3, 6, 9 and 12 months after surgery to evaluate urinary continence. The maximum urethral closure pressure (MUCP) was also measured before and after surgery by measuring urethral pressure (UPP). The correlation between postprostatectomy incontinence (PPI) and various factors was analyzed by regression analysis. RESULTS: The urinary incontinence rates which was evaluated by one-hour pad test, at 1, 3, 6, 9 and 12 months after surgery were 40.2%, 63.5%, 73.1%, 74.6% and 76.8%, respectively. A significant correlation between PPI (1,3,6,9 and 12M) and postoperative PRM cross-sectional area change after RARP (p-value: <0.01, <0.001, <0.001, <0.01, <0.001) was observed. A significant correlation was also observed between changes PRM cross sectional area and pubic bone-perineal body (PP) distance changes and vesicourethral junction (VUJ) distance change (p-value: <0.01, <0.01). A significant correlation between PPI (1,3,6,9 and 12M) and PP (OR:-0.20,-0.32,-0.26,-0.22,-0.20, p-value: <0.001, <0.001, <0.001, <0.001, <0.001, respectively), VUJ before and after abdominal pressure loading (OR: -0.31, -0.42, -0.34, -0.28, -0.31, p-value: <0.01, <0.001, <0.001, <0.01, <0.001, respectively) was observed by cineMRI. CONCLUSIONS: The PRM is thought to be directly or indirectly connected to the RUM. It is speculated that the PRM muscle and the RUM work as a sling and affect urinary continence. Postoperative reduction of PRM cross-sectional area caused a decrease in the function of the support mechanism as a urethral sling, which affected distance between PP or VUJ and as a result, induced PPI. The levator ani muscles functioned as a sling and was thought to be associated with urinary continence by adding force toward the pubis to the VUJ. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e893 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masao Kataoka More articles by this author Tomoyuki Koguchi More articles by this author Junya Sato More articles by this author Yuichi Sato More articles by this author Hidenori Akaihata More articles by this author Yoshiyuki Kojima More articles by this author Expand All Advertisement PDF DownloadLoading ...

AdVance and AdVance XP Male Sling Comparison, an Institutional Experience

ABSTRACT Introduction The AdVance male sling has been used for many years for the treatment of male stress urinary incontinence with multiple previous studies evaluating its efficacy. More recently, a new generation AdVance XP was designed with modifications in its design and surgical tools in hopes to improve patient outcomes. Objective The aim of our study was to provide our institution's outcomes comparing objective and patient-reported outcomes of the AdVance male sling to the AdVance XP. Methods All patients who have had placement of an AdVanceXP male urethral sling were retrospectively reviewed. Inclusion criteria included the necessity of one year post-operative follow up. We then identified a comparative cohort who had the most recent placement of the AdVance sling. We compared patient demographics, baseline characteristics, functional outcomes, voiding studies and complications. Results A total of 11 patients who received the AdVanceXP were compared to 11 patients who received the AdVance male sling. There were no statistically significant differences in baseline demographics between the two groups (Table1). When comparing the AdVance XP to Advance, there was no difference in change in average flow rate (-1.26mL/s vs -5mL/s, p=0.476) or peak flow (-5.11mL/s vs -5.73mL/s, p=.936). Patient's pre-surgical pad usage was greater in the AdVanceXP than the AdVance sling groups (2.64 vs 1.60, p=0.019). The mean decrease in pad usage was 1.95 pads in those with the AdVanceXP compared to 1.36 pads with the AdVance (p=.227). There were no statistically significant differences in operative times between the AdVanceXP and the AdVance male sling (64.5min vs 68.8min, p=.249). Both groups had one patient who had issues with post-operative pain and neither group had any patients with post-operative retention, infection or need for reoperation within one year. Conclusions Patient's who had placement of the AdVanceXP were found to have a greater reduction in pad usage when compared to the AdVance sling, though not reaching statistical significance. Disclosure No

Does Medicaid Cover Male Urethral Sling Surgery? A State-by-State Analysis

ABSTRACT Introduction Male suburethral slings are one treatment option for stress urinary incontinence (SUI) due to intrinsic sphincter deficiency post-prostatectomy in appropriately selected patients. Some studies report up to 55% social continence, and 23% of respondents reduced use of pads by greater than 50%. Male slings may be preferred in men with limited manual dexterity who have difficulty manipulating an artificial urinary sphincter, or in men with more mild SUI, particularly if there is no history of prior radiation. Existing literature regarding insurance coverage and physician reimbursement overwhelmingly focuses on Medicare and commercial plans, leaving a knowledge gap with respect to the Medicaid population which may contribute to inequitable utilization of this treatment modality for SUI. Objective To quantify Medicaid coverage for placement and revision of male suburethral slings for correction of male SUI by state. Methods State Medicaid websites were utilized to access publicly available physician fee schedules. Individual search queries were performed for CPT codes 53440 and 53442, which represent sling operation for correction of male urinary incontinence and removal or revision of sling for male urinary incontinence, respectively. Data were recorded for each device, including the coverage status and physician fees. Results Medicaid physician fee schedules were accessible for 49 out of 50 US states. All 49 of these states reported coverage for placement of a male urethral sling, and 48 states reported coverage for removal or revision of a male urethral sling. Means and range of physician reimbursement for each procedure were $834.26 ($198.00-$5,237.35) for placement of a male urethral sling (53440) and $616.88 ($104.27-$2,288.93) for removal or revision of a male urethral sling (53442). Conclusions Male suburethral sling placement and revision for SUI in the Medicaid population are covered by nearly all states as confirmed by publicly available data. Knowledge of Medicaid coverage for SUI related surgery may result in improvement in the utilization of this treatment option for male SUI and may improve quality of life in the Medicaid cancer survivorship population. Disclosure No

Comparison of Morphological and Histological Characteristics of Human and Sheep: Sheep as a Potential Model for Testing Midurethral Slings in vivo

Introduction: The sheep was evaluated as a potential model for preclinical evaluation of urethral slings in vivo based on: (1) anatomical measurements of the sheep vagina and (2) histological tissue integration and host response to polypropylene (PP) slings. Methods: Eight female, multiparous sheep were utilized. Three of 8 animals underwent surgery mimicking human tension-free vaginal tape protocols for midurethral slings and were euthanized at 6 months. The following measurements were obtained: vaginal length, maximum vaginal width with retraction, symphysis pubis length, and distance from the pubic bone to incision. Explanted sling samples from sheep and human were stained with hematoxylin and eosin for host reaction assessment. Results: Geometric measurements were similar between humans and sheep. Sheep vaginal anatomy allowed sling placement similar to procedures in human surgeries, and all sheep recovered without problems. Comparative histology between the sheep and human indicated similar host reaction and collagen deposition around implants, confirming suitability of the sheep model for biomaterial response assessment. Conclusion: Sheep vaginal length is comparable to humans. Tissue integration and host response to PP slings showed chronic inflammation with rich collagen deposition around the material in both sheep and human specimens, highlighting the sheep as a potential animal model for preclinical testing of midurethral slings.

Persistent peri-anal vaginocutaneous fistula/sinus tract associated with chronically infected synthetic transobturator mid urethral slings

The objectives of our video are to highlight that persistent vaginocutaneous fistulas or sinus tracts can be associated with chronically infected macroporous (Type 1) synthetic transobturator slings, to discuss common presenting features and the importance of removal of the infected mesh and to demonstrate our surgical approach to excising chronically infected synthetic transobturator slings. We present a 61-year-old patient with a persistent non-healing right perianal vaginocutaneous fistula/sinus tract following incision and drainage of a right ischiorectal abscess 1 year prior. She has a history of transobturator tape sling placement 15 years prior for stress urinary incontinence and a subsequent vaginal mesh excision for vaginal mesh exposure 4 years prior. Her main complaint was persistent foul-smelling vaginal discharge and a non-healing right perianal wound. Despite undergoing multiple perianal debridement procedures her symptoms persisted. We had a high suspicion that her transobturator sling was the nidus for the persistent non-healing wound, thus we proceeded with an exam under anesthesia and right transobturator mesh excision. Removal of a transparent synthetic transobturator sling can be challenging. In this video we demonstrate our approach to removal of transobturator slings and discuss important surgical considerations to help with identification of transparent transobturator mesh slings. In conclusion, a strategic approach to transobturator synthetic mesh sling excision may allow for successful mesh identification and removal while minimizing complications.

Exploratory safety study of an umbilical cord derived urethral sling in bilateral pudendal nerves injury-induced urinary incontinence in female rats.

Mid-urethral slings are the standard treatment for women with refractory stress urinary incontinence (SUI) but are at riskof infection or erosion due to host-prothesis interaction. In this proof-of-concept study, we aimed at evaluating umbilical vessel sling (UVS) in incontinent female rats. UVS wasextracted from human umbilical cord lining and was placed on female rats who underwent bilateral pelvic nerve injury (PNI) to reproduce SUI (Group 3, N = 10). Two control groups were also studied: rats with no PNI (Group 1, N = 4) and rats with PNI but no UVS (Group 2, N = 10). Micturition calendar was frequently recorded using a metabolic cage, and leak point pressure (LPP) test was performed on Day 28. After the LPP test, rats were euthanized, and bladder/urethra were collected for histopathological analysis. Overall, 24 rats were included,of whom 10 had both PNI and UVS placement. Compared with Group 2, Group 3 had increased maximal LPP but the difference did not reach significance (respectively 21.8 ± 2.1 mmHg vs. 28.4 ± 4.1 mmHg, p = 0.2). Micturition frequencies were similar between the groups. Total voided volume was higher in Group 3 at the end of the study compared with Group 2 (12.5 ± 1.1 ml vs. 9.4 ± 0.6 ml,respectively, p < 0.05). Histopathological findings evidenced a good local tolerance and a moderate to high tissue integration of the UVS. Biological sling derived from human umbilical vessel could be safely placed with a slight improvement of LPP in a population of rats who had bilateral PNI without major modification of micturition calendar. UVS could be a promising biomaterial in the management of SUI in women. Clinical studies are needed.

A0572 - Evaluation of the effect of umbilical cord derived urethral slings in bilateral pudendal nerves injury-induced urinary incontinence in female rats

A0572 - Evaluation of the effect of umbilical cord derived urethral slings in bilateral pudendal nerves injury-induced urinary incontinence in female rats

Prior Placement of Male Urethral Slings Can Increase the Need for Revision of Artificial Urinary Sphincters.

Background: Recurrent stress urinary incontinence (SUI) following male sling can be managed surgically with artificial urinary sphincter (AUS) insertion. Prior small, single-center retrospective studies have not demonstrated an association between having failed a sling procedure and worse AUS outcomes. The aim of this study was to compare outcomes of primary AUS placement in men who had or had not undergone a previous sling procedure. Methods: A retrospective review of all AUS devices implanted at a single academic center during 2000–2018 was performed. After excluding secondary AUS placements, revision and explant procedures, 135 patients were included in this study, of which 19 (14.1%) patients had undergone prior sling procedures. Results: There was no significant difference in demographic characteristics between patients undergoing AUS placement with or without a prior sling procedure. Average follow up time was 28.0 months. Prior sling was associated with shorter overall device survival, with an increased likelihood of requiring revision or replacement of the device (OR 4.2 (1.3–13.2), p = 0.015) as well as reoperation for any reason (OR 3.5 (1.2–9.9), p = 0.019). While not statistically significant, patients with a prior sling were more likely to note persistent incontinence at most recent follow up (68.8% vs. 42.7%, p = 0.10). Conclusions: Having undergone a prior sling procedure is associated with shorter device survival and need for revision or replacement surgery. When considering patients for sling procedures, patients should be counseled regarding the potential for worse AUS outcomes should they require additional anti-incontinence procedures following a failed sling.

The male sling for stress urinary incontinence: tips and tricks for success.

ABSTRACTUrethral slings are a good treatment option for mild male stress urinary incontinence. There are many different sling options, but herein our group describes our techniques with the Advance® and Virtue® slings. More important than technique, we strongly think that patient selection is paramount to sling success. We only offer slings to patients who have low 24 hour pad weights, high Valsalva leak point pressure, and no history of pelvic radiation. Still, like with any surgery, we recommend that the surgeons implant the device that they are most comfortable with along with their chosen techniques.

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

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

Cost Value Analysis of Single Incision Midurethral Sling Insertion in the In Office Vs. Hospital Setting

<h3>Study Objective</h3> Patient outcomes between Mid-urethral slings in office setting vs hospital setting based on average total patient encounter time, total procedure time, total patient cost. The secondary outcomes were adverse events, unexpected outcomes, and urgent evaluation. <h3>Design</h3> Retrospective, double-arm study, 1 physician implanted a mid-urethral single-incision sling with the clinical diagnosis for urethral hypermobility or stress urinary incontinence. <h3>Setting</h3> Office setting and hospital-based setting. <h3>Patients or Participants</h3> 78 women underwent sling placement in an office setting and 47 patients underwent sling placement in a hospital-based setting. <h3>Interventions</h3> Patients were evaluated at 2 and 6 weeks after surgery. A validated Surgical Satisfaction Questionnaire (SSQ-8) was collected at the 6-week post-operative visit. Patients that did not complete the SSQ-8 were contacted by phone. All women with the diagnosis of urethral hypermobility or stress urinary incontinence. <h3>Measurements and Main Results</h3> Between January 2016 until August 2020 a total of 125 women underwent a single incision mid urethral sling procedure. Hospital-based setting: The average SSQ-8 score totaled 39.17 out of 40. The average total patient encounter time was 344.702 minutes. The average total time in the OR was 50.06 minutes. 5 total patients reported one adverse event, 13 patients reported 6 unexpected outcomes. No patients were seen for emergent evaluation. Office-based setting: The average SSQ-8 score totaled 39.48 out of 40. The average total patient encounter time was 53.76 minutes. The average total time in the OR was 22.05 minutes. 5 total patients reported one adverse event, 25 patients reported 27 unexpected outcomes. 1 patient was seen for emergent evaluation. No statistically significant differences in patient satisfaction. <h3>Conclusion</h3> The findings have shown considerable favor office-based setting in comparison to the hospital setting. There is a significant difference in the financial cost and the total patient encounter time. The office-based setting would be the more advantageous option for patients. The office-based setting is cost-effective, less time-consuming, and is safe.

Regarding the diagnosis of detrusor underactivity in: “Urodynamics criteria of detrusor underactivity in women underwent middle urethral sling for stress urinary incontinence: What is the clinical role? Neurourol Urodyn 2021. August 22. doi.org/10.1002/nau.24773”

Regarding the diagnosis of detrusor underactivity in: “Urodynamics criteria of detrusor underactivity in women underwent middle urethral sling for stress urinary incontinence: What is the clinical role? Neurourol Urodyn 2021. August 22. doi.org/10.1002/nau.24773”