Recurrent Incontinence After Transvaginal Partial Sling Excision in Patients with Prior Mid-Urethral Sling
Received 25 September 2020
Accepted for publication 16 December 2020
Published 12 January 2021 Volume 2021:13 Pages 9—15
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Jan Colli
Robert Shapiro,1,2 Omar Felipe Dueñas-Garcia,1 Manuel Vallejo,1 Tyler Trump,2 Makenzy Sufficool,3 Stanley Zaslau1,2
1Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, WV 26506, USA; 2Department of Urology, West Virginia University School of Medicine, Morgantown, WV 26506, USA; 3West Virginia University School of Medicine, Morgantown, WV 26506, USA
Correspondence: Robert Shapiro
Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
Introduction: Patients may develop recurrent urinary tract infections, pain syndromes, dyspareunia, and voiding difficulty after mid-urethral sling placement that can be treated by partial sling excision.
Objective: The primary objective of this study was to evaluate the incidence of de novo incontinence and voiding difficulty after partial sling excision. A secondary objective was to assess risk factors associated with future incontinence surgery in this subset of patients.
Methods: From 2009 to 2017, 95 female patients with subjective complaints of pelvic pain, dyspareunia, or voiding difficulty following synthetic mid-urethral sling placement for stress urinary incontinence underwent partial sling excision at a single institution. The incidence of urinary incontinence was assessed 6 months after partial sling excision. Patients were also assessed for resolution of voiding difficulty and future incontinence surgery. Primary endpoints were examined by Pearson’s Chi-square test and interval data by t-test. A p < 0.05 was significant.
Results: About 72% of patients were more likely to be continent after partial sling excision irrespective of initial symptoms prior to surgery. No difference was seen in voiding difficulty between the continent and incontinent patients after partial sling excision (p=0.09). Patients with a retropubic mid-urethral sling were more likely to be continent after partial sling excision (p=0.03). Preoperative maximum flow rate > 16 mL/sec was associated as an independent variable to develop incontinence surgery after partial sling excision (p=0.009).
Conclusion: In conclusion, partial sling excision poses a low risk for de novo urinary incontinence regardless of preoperative symptoms. Stress urinary incontinence may be less likely to reoccur in those patients having a retropubic approach. A preoperative maximum flow rate of > 16 mL/sec is a risk factor for future incontinence surgery after partial sling excision and should be taken into consideration when formulating a treatment plan.
Keywords: sling excision, mesh, incontinence, mid-urethral sing
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