To evaluate urinary incontinence outcomes following synthetic sub-urethral sling removal (SSR) in women.
We reviewed a prospectively-maintained database of 360 consecutive women who underwent transvaginal SSR from 2005-2015.
We excluded patients with neurogenic bladder, non-synthetic or multiple slings, prior mesh for prolapse, concomitant surgery during sling excision, urethral erosion or fistula, post-operative retention, or <6 months follow-up. Demographics, sling type, indications for removal, time to removal, and patient-reported outcomes were recorded. Outcomes were stratified by incontinence type: stress-predominant (SUI), urge-predominant (UUI), and mixed (MUI). Subsequent management (observation, minimally-invasive outpatient interventions (bulking agents, neuromodulation, onabotulinumtoxinA), or more invasive surgery (autologous fascial sling, bladder suspension)) was evaluated. No patients elected to receive subsequent synthetic sling. Success was defined by responses to UDI-6 questions 2 and 3, self-reported satisfaction with continence at last visit, and no further intervention.
99 patients met inclusion criteria, of whom 27 denied any subjective leakage following SSR alone, while 72 experienced some degree of incontinence post-SSR: 26 SUI (7 persistent, 19 de novo), 14 UUI (6 persistent, 8 de novo), and 32 MUI (13 persistent, 19 de novo). Mean follow-up was 23 months (range 6-114). Success rates following a single minimally-invasive intervention after SSR were 81% in patients with SUI, 86% in patients with UUI, and 75% in patients with MUI.
Patients undergoing SSR may exhibit urinary control or de novo or persistent incontinence, with a higher predilection for SUI or MUI. However, after a single minimally-invasive intervention following SSR, success rates reached 75-86%.
The Journal of urology. 2017 Mar 03 [Epub ahead of print]
Nirmish Singla, Himanshu Aggarwal, Jeannine Foster, Feras Alhalabi, Gary E Lemack, Philippe E Zimmern
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/28267602
Go "Beyond the Abstract" - Read an article commentary written by the authors