Adult urologyEarly results of pubovaginal sling lysis by midline sling incision
Section snippets
Material and methods
We reviewed the charts of 19 women who underwent transvaginal sling incision for obstruction after pubovaginal sling placement for stress incontinence. All patients had undergone a complete history taking, physical examination, postvoid residual urine determination, multichannel videourodynamic studies, and cystoscopy. All were deemed to have obstruction on the basis of a combination of clinical (history, physical examination findings, preoperative voiding status), urodynamic (relatively high
Results
The mean patient age was 57 years (range 35 to 75). All patients reported “normal emptying” before sling surgery. Fifteen women (79%) had an autologous fascial sling, three (16%) an allographic fascia lata sling, and one (5%) a synthetic (polypropylene) sling. The sling was identified and incised in all patients by the described technique. The mean time to takedown of the sling was 10.6 months (range 3 to 72).
Twelve women (63%) presented with partial or complete urinary retention and were
Comment
Suburethral slings are now widely accepted as both primary and secondary treatment for all types of stress incontinence. Numerous techniques have been described, and common sling materials include autologous and allograft fascia and synthetic mesh. Successful placement of a suburethral sling requires a balance between providing support and avoiding obstruction. To date, no standardized technique for determining the ideal sling tension exists, but most experts recommend that the sling be tied
Conclusions
Transvaginal sling incision appears to be a safe and efficacious method to treat obstruction after pubovaginal sling placement. It is technically easier than formal urethrolysis and has a low morbidity. The success rates and recurrent stress incontinence rates compare favorably with formal urethrolysis. It should be considered as a first-line treatment of an obstructing pubovaginal sling.
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Cited by (96)
Synthetic Midurethral Slings: Roles, Outcomes, and Complications
2019, Urologic Clinics of North AmericaReply by the Authors
2018, UrologyFemale Outlet Obstruction After Anti-incontinence Surgery
2018, UrologyCitation Excerpt :Urethrolysis is not the only treatment available for patients following a pubovaginal sling placement. These patients can be managed with a simple sling incision.40,41,45 In patients who undergo excision, typically a partial excision of the sling is done initially; however, complete excision may be necessary for patients with pelvic pain or mesh exposure.1
Management of Urinary Incontinence Following Suburethral Sling Removal
2017, Journal of UrologyLong-term functional results after unilateral mid-urethral sling transection for voiding dysfunction
2016, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :No patients had an overactive detrusor at this stage. In this study, urodynamic criteria for obstruction as an indication for surgical transection were not used routinely; several studies in the past have shown that these criteria are poor predictors for the outcome of urethrolysis, and that a normal urodynamic study does not preclude a women from having iatrogenic urinary obstruction [5,6,10]. The number of incontinence pads required per 24-h period was used to evaluate SUI.
Urgency Incontinence before and after Revision of a Synthetic Mid Urethral Sling
2016, Journal of UrologyCitation Excerpt :Retention requiring catheterization and obstructive voiding symptoms resolved in more than 95% and 75% of patients, respectively (table 1), consistent with previously reported rates in the literature of 82% to 97%.3,4 However, rates of resolution of storage symptoms vary widely in the literature from 35% to 85%.3–8 Of the 68 patients with UUI before revision 76.5% reported persistent UUI symptoms after revision in this cohort.