Elsevier

Urology

Volume 59, Issue 1, January 2002, Pages 47-51
Urology

Adult urology
Early results of pubovaginal sling lysis by midline sling incision

https://doi.org/10.1016/S0090-4295(01)01559-XGet rights and content

Abstract

Objectives. To describe a simplified technique and results of pubovaginal sling lysis by incision of the sling in the midline by way of a transvaginal approach.

Methods. We reviewed the charts of 19 women who underwent pubovaginal sling lysis for obstruction. Patients presenting with retention, incomplete emptying or storage, or voiding symptoms suggesting obstruction after pubovaginal sling placement were evaluated with videourodynamic studies and cystourethroscopy. The diagnosis of obstruction was made on the basis of a combination of clinical, urodynamic, and endoscopic findings. All patients underwent a midline incision of the sling by way of a transvaginal approach without formal urethrolysis.

Results. The mean patient age was 57 years. Fifteen women (79%) had an autologous rectus fascial sling, 3 (16%) an allographic fascia lata sling, and 1 (5%) a polypropylene sling. Twelve women (63%) presented with urinary retention and required catheterization to empty. The other 7 women presented with obstructive and/or irritative symptoms without the need to catheterize. The mean time to sling lysis was 10.6 months from the initial surgery. The mean follow-up was 12 months (range 1 to 55). Overall, sling lysis was successful in 84% of the women. Stress incontinence recurred in 17%. No significant perioperative complications occurred.

Conclusions. Pubovaginal sling lysis without formal urethrolysis appears to be a safe and effective method of relieving obstruction. The success and recurrent stress incontinence rates are comparable to those with formal urethrolysis.

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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