How long after surgery should one wait to determine if a MUS has failed?
He notes that since aging results in tissue deterioration, pelvic organ prolapse and detrusor dysfunction, many older women will eventually develop some degree of failure of their MUS. He noted that a confounding factor is the definition of success or “cure,” noting Ward and Hilton's (2002) cure definitions at 6 months past-surgery. Parameters for MUS failure include persistent UI (SUI versus UUI), de novo voiding dysfunction, complications, patient dissatisfaction and unmet expectations. Tools such as an physical exam, UDS, diary, pads, etc. may be helpful in determining why the MUS has failed but the cause may not always be obvious. He noted that a fascial sling after a failed MUS is a good rescue operation for a mesh catastrophe but is maximally invasive and there is little to no data on outcomes. He noted that the number one reason for re-intervention after tension-free slings is obstruction. If there is post-operative bladder outlet obstruction (BOO) then it needs to be fixed - and the earlier the better. Management includes loosening the sling (which is time dependent), transvagnial sling incision, which has a low risk of recurrent SUI or urethrolysis which is rare. If sling erosion occurs then follow the 3 “Rs”: remove, repair and re-evaluate another day. He then presented his algorithm for reoperation in a patient with a failed MUS.
Presented by Eric Rovner, MD at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Diane K. Newman, RNC, MSN, CRNP, FAAN and Continence Nurse Practitioner Specialist - University of Pennsylvania Medical Center.
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