Implantation of a synthetic midurethral sling (SMUS) is the most commonly performed anti-incontinence operation in women worldwide. The effectiveness of the SMUS is comparable to that of the historical gold standards-autologous fascial slings and the Burch colposuspension.
Much controversy, however, has evolved regarding the safety of this type of sling Overall, the quality of the studies with respect to assessing risks of SMUS-associated complications is currently poor The most common risks in patients with SMUS include urethral obstruction requiring surgery (2 3% of patients with SMUS), vaginal, bladder and/or urethral erosion requiring surgery (1 8%) and refractory chronic pain (4 1%); these data likely represent the minimum risks In addition, the failure rate of SMUS implantation surgery is probably at least 5% in patients with stress urinary incontinence (SUI) Furthermore, at least one-third of patients undergoing sling excision surgery develop recurrent SUI Considering the additional risks of refractory overactive bladder, fistulas and bowel perforations, among others, the overall risk of a negative outcome after SMUS implantation surgery is ≥15%
Nature reviews Urology 2015 Aug 18 [Epub ahead of print]
Jerry G Blaivas, Rajveer S Purohit, Matthew S Benedon, Gabriel Mekel, Michael Stern, Mubashir Billah, Kola Olugbade, Robert Bendavid, Vladimir Iakovlev
Department of Urology, Weill Cornell Medical College, Cornell University, 445 East 77th Street, New York, NY 10075, USA , Department of Urology, Weill Cornell Medical College, Cornell University, 445 East 77th Street, New York, NY 10075, USA , Institute for Bladder and Prostate Research, Weill Cornell Medical College, Cornell University, 445 East 77th Street, New York, NY 10075, USA , Hahnemann University Hospital, 230 North Broad Street, Philadelphia, PA 19102, USA , SUNY Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, NY 11203, USA , SUNY Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, NY 11203, USA , SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA , Shouldice Hospital, 7750 Bayview Avenue, Thornhill, ON L3T 4A3, Canada , St Michael's Hospital, University of Toronto, 30 Bond Street, ON M5B 1W8, Canada