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Synthetic Midurethral Slings: Urinary Tract Sequelae

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Complications of Female Incontinence and Pelvic Reconstructive Surgery

Abstract

The midurethral sling (MUS) is considered by many to be the standard of care for the treatment of stress urinary incontinence (SUI). Complications from MUS surgery unique to the use of polypropylene mesh may occur including: chronic pelvic pain, dyspareunia, mesh exposure, mesh contracture, neuromuscular injury, and/or organ perforation. In addition, there can be significant urinary tract sequelae such as urinary tract injury, de novo urgency and/or urgency urinary incontinence (UUI), urinary obstruction, and/or urinary tract infection (UTI). Techniques for prevention, diagnosis, and treatment of such urinary tract complications are discussed herein.

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References

  1. Reynolds WS, Dmochowski RR, Penson DF. Epidemiology of stress urinary incontinence in women. Curr Urol Rep. 2011;12(5):370–6.

    Article  PubMed  Google Scholar 

  2. Anger JT, Weisenberg AE, Albo ME, et al. Trends in surgical management of stress urinary incontinence among female Medicare beneficiaries. J Urol. 2009;74(2):283–7.

    Article  Google Scholar 

  3. Wood L, Anger J. Urinary incontinence in women. BMJ. 2014;349:g4531.

    Article  PubMed  Google Scholar 

  4. Dmochowski R, Blaivas J, Gormley EA, et al. Update of AUA Guideline on the surgical management of female stress urinary incontinence. J Urol. 2010;183:1906–14.

    Article  PubMed  Google Scholar 

  5. Mohr S, Kuhn P, Mueller MD, et al. Painful love-“hispareunia” after sling erosion of the female partner. J Sex Med. 2011;8(6):1740–6.

    Article  PubMed  Google Scholar 

  6. Murray S, Haverkorn RM, YK K, et al. Urethral distortion after placement of synthetic mid urethral sling. J Urol. 2011;185(4):1321–6.

    Article  PubMed  Google Scholar 

  7. Nitti V, Tu LM, Gitlin J. Diagnosing bladder outlet obstruction in women. J Urol. 1999;161:1535–40.

    Article  CAS  PubMed  Google Scholar 

  8. Staack A, Vitale J, Ragavendra N, et al. Translabial ultrasonography for evaluation of synthetic mesh in the vagina. Urology. 2014;83:68–74.

    Article  PubMed  Google Scholar 

  9. Richter HE, Albo ME, Zyczynski HM, et al. Retropubic versus transobturator midurethral slings for stress incontinence. NEJM. 2010;362(22):2066–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Chang-Kit L, Kaufman M, Dmochowski R. Complications of biologic and synthetic slings and their management. In: Goldman H, editor. Complications of female incontinence and pelvic reconstructive surgery. London: Springer; 2013.

    Google Scholar 

  11. AUA best practice policy statement on urologic surgery antimicrobial prophylaxis. 2008. https://www.auanet.org/education/guidelines/antimicrobial-prophylaxis.cfm.

  12. Jackson D, Higgins E, Bracken J, et al. Antibiotic prophylaxis for urinary tract infection after midurethral sling: a randomized controlled trial. Fem Pel Med Recon Surg. 2013;12(3):137–41.

    Article  Google Scholar 

  13. Gehrich A, Lustik M, Mehr A, et al. Risk of postoperative urinary tract infections following midurethral sling operations in women undergoing hysterectomy. Int Urogynecol J. 2016;3(27):483–90.

    Article  Google Scholar 

  14. Mishra VC, Mishra N, Karim OMA, et al. Voiding dysfunction after tension-free vaginal tape: a conservative approach is often successful. Int Urogynecol J. 2005;16:210–5.

    Article  Google Scholar 

  15. Holgren C, Nilsson S, Lanner L. Frequency of de novo urgency in 463 women who had undergone tension-free vaginal tape (TVT) procedure for genuine stress urinary incontinence-a long term follow-up. Obstet Gynecol. 2007;132:121–5.

    Google Scholar 

  16. Lee J, Dwyer P, Rosamilla A. Which women develop urgency or urgency urinary incontinence following midurethral slings? Int Urogynecol J. 2013;24:47–54.

    Article  PubMed  Google Scholar 

  17. Abraham N, Vasavada S. Urgency after sling: review of the management. Curr Urol Rep. 2014;15:400.

    Article  PubMed  Google Scholar 

  18. Segal J, Vassallo B, Kleeman S, et al. Prevalence of persistent and de novo overactive bladder symptoms after the tension-free vaginal tape. Obstet Gynecol. 2004;104(6):1263–9.

    Article  PubMed  Google Scholar 

  19. Gormley EA, Lightner D, Faraday M, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol. 2015;193:1572–80.

    Article  PubMed  Google Scholar 

  20. Serati M, Braga A, Sorice P, et al. Solifenacin in women with de novo overactive bladder after tension-free obturator vaginal tape-is it effective? J Urol. 2014;191:1322–6.

    Article  CAS  PubMed  Google Scholar 

  21. Miotla P, Futyma K, Cartwright R, et al. Effectiveness of botulinum toxin injection in the treatment of de novo OAB symptoms following midurethral sling surgery. Int Urogynecol J. 2016;3(27):393–8.

    Article  Google Scholar 

  22. Patel B, Kobashi K, Staskin D. Iatrogenic obstruction after sling surgery. Nat Rev Urol. 2012;9:429–34.

    Article  PubMed  Google Scholar 

  23. Shah S, Nitti V. Diagnosis and treatment of obstruction following anti-incontinence surgery-urethrolysis and other techniques. In: Cardozo L, Staskin D, editors. Textbook of female urology and urogynecology, Vol. II. 3rd ed. London: Informa Healthcare; 2010. p. 749–62.

    Google Scholar 

  24. Aponte MM, Shah SR, Hickling D, et al. Urodynamics for clinically suspected obstruction after anti-incontinence surgery in women. J Urol. 2013;190(2):598–602.

    Article  PubMed  Google Scholar 

  25. Lee D, Bacsu C, Zimmern P. Meshology: a fast-growing field involving mesh and/or tape removal procedures and their outcomes. Expert Rev Med Devices. 2015;12(2):201–6.

    Article  CAS  PubMed  Google Scholar 

  26. Scarpero HM, Dmochowski RR, Nitti VW. Repeat urethrolysis after failed urethrolysis for iatrogenic obstruction. J Urol. 2003;169:1013–6.

    Article  PubMed  Google Scholar 

  27. Nguyen JN. Tape mobilization for urinary retention after tension-free vaginal tape procedures. Urology. 2005;66:523–6.

    Article  PubMed  Google Scholar 

  28. Goldman HB. Simple sling incision for the treatment of iatrogenic urethral obstruction. Urology. 2003;62:714–8.

    Article  PubMed  Google Scholar 

  29. Webster GD, Kreder KJ. Voiding dysfunction following cystourethopexy: its evaluation and management. J Urol. 1990;144:670–3.

    CAS  PubMed  Google Scholar 

  30. Petrou SP, Young PR. Rate of recurrent stress urinary incontinence after tretropubic urethrolysis. J Urol. 2002;167:613–5.

    Article  PubMed  Google Scholar 

  31. Petrou SP, Brown JA, Blaivas JG. Suprameatal transvaginal urethrolysis. J Urol. 1999;161:1268–71.

    Article  CAS  PubMed  Google Scholar 

  32. Carr LK, Webster GD. Voiding dysfunction following incontinence surgery: diagnosis and treatment with retropubic or vaginal urethrolysis. J Urol. 1999;161:1535–40.

    Article  Google Scholar 

  33. Starkman J, Duffy J, Wolter C, et al. The evolution of obstruction induced overactive bladder symptoms following urethrolysis for female bladder outlet obstruction. J Urol. 2008;179:2028–3.

    Google Scholar 

  34. Anger JT, Amundsen CL, Webster GD. Obstruction after Burch colposuspension: a return to retropubic urethrolysis. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(5):455–9.

    Article  PubMed  Google Scholar 

  35. Austin P, Spryropoulos E, Lotenfoe R, et al. Urethral obstruction after anti-incontinence surgery in women: evaluation, methodology, and surgical results. Urology. 1996;47:890–4.

    Article  CAS  PubMed  Google Scholar 

  36. Amundsen CL, Buralnick ML, Webster GD. Variations in strategy for the treatment of urethral obstruction after a pubovaginal sling procedure. J Urol. 2000;164:434–7.

    Article  CAS  PubMed  Google Scholar 

  37. Carey JM, Chon JK, Leach GE. Urethrolysis with Martius labial fat pad for iatrogenic bladder outlet obstruction. Urology. 2003;61:21–5.

    Article  PubMed  Google Scholar 

  38. Foster HE, McGuire EJ. Management of urethral obstruction with transvaginal urethrolysis. J Urol. 2005;150:1448–51.

    Google Scholar 

  39. Nitti V, Raz S. Obstruction following anti-incontinence procedures: diagnosis and treatment with retropubic or vaginal urethrolysis. J Urol. 1997;157:821–3.

    Article  Google Scholar 

  40. Cross CA, Cespedes RD, English SF, et al. Transvaginal urethrolysis for urethral obstruction after anti-incontinence surgery. J Urol. 1998;159:1199–201.

    Article  CAS  PubMed  Google Scholar 

  41. Goldman HB, Rackley PR, Appell RA. The efficacy of urethrolysis without resuspension for iatrogenic urethral obstruction. J Urol. 1999;161(1):196–8.

    Article  CAS  PubMed  Google Scholar 

  42. McCrery R, Appell R. Transvaginal urethrolysis for obstruction after antiincontinence surgery. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(6):627–33.

    Article  PubMed  Google Scholar 

  43. Nitti VW, Carlson KV, Blaivas JG, et al. Early results of pubovaginal sling lysis by midline sling incision. Urology. 2002;59:47–51.

    Article  PubMed  Google Scholar 

  44. Abraham N, Makovey I, King A, et al. The effect of time to release of an obstruction synthetic mid-urethral sling on repeat surgery for stress urinary incontinence. Neurourol Urodyn. 2015. epub ahead of print.

    Google Scholar 

  45. Yoost T, Rames R, Lebed B, et al. Predicting for postoperative incontinence following sling release. Int Urogynecol J. 2011;22:665.

    Article  PubMed  Google Scholar 

  46. Starkman JS, Duffy J, Wolter C, et al. Refractory overactive bladder after urethrolysis for bladder outlet obstruction: management with sacral neuromodulation. Int Urogynecol J. 2008;19:277–82.

    Article  Google Scholar 

  47. Osborn D, Dmochowski R, Harris C, et al. Analysis of patient and technical factors associated with midurethral sling mesh exposure and perforation. Int J Urol. 2014;21:1167–70.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Oh TH, Ryu DS. Transurethral resection of intravesical mesh after midurethral sling procedures. J Endourol. 2009;181(5):2198–202.

    Google Scholar 

  49. Dounouchtsis SK, Lee F, Bramwell D, et al. Evaluation of holmium laser for managing mesh/suture complications of continence surgery. BJUI. 2011;108:1472–8.

    Article  Google Scholar 

  50. Shah K, Nikolavsky D, Gilsdorf D, et al. Surgical management of lower urinary mesh perforation after mid-urethral polypropylene mesh sling: mesh excision, urinary tract reconstruction and concomitant pubovaginal sling with autologous rectus fascia. Int Urogynecol J. 2013;24:2111–7.

    Article  PubMed  Google Scholar 

  51. Blaivas J, Mekel G. Management of urinary fistulas due to midurethral sling surgery. J Urol. 2014;192:1137–42.

    Article  PubMed  Google Scholar 

  52. Blaivas J, Purohit R, Weinberger J, et al. Salvage surgery after failed treatment of synthetic mesh sling complications. J Urol. 2013;190(4):1281–6.

    Article  PubMed  Google Scholar 

  53. Hansen B, Dunn G, Norton P, et al. Long-term followup of treatment for synthetic mesh complications. Fem Pel Med Recon Surg. 2014;20(3):126–30.

    Article  Google Scholar 

  54. FDA’s roles and activities: The US Food and Drug Administration. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/UroGynSurgicalMesh/ucm262301.htm.

  55. AUGS-SUFU position statement on mesh midurethral slings for SUI. http://sufuorg.com/docs/news/augs-sufu-mus-position-statement-approved-1-3-2014.aspx.

  56. American Urologic Association (AUA) position statement on the use of vaginal mesh for the surgical treatment of stress urinary incontinence. 2012. www.auanet.org/education/vaginal-mesh-for-sui.cfm.

  57. Kuhlmann-Capek M, Kilic G, Shah A, et al. Enmeshed in controversy: use of vaginal mesh in the current medicolegal environment. Female Pelv Med Reconstr Surg. 2015;21(5):241–3.

    Article  Google Scholar 

  58. Miller D, Milani AL, Sutherland SE, et al. Informed surgical consent for a mesh/graft-augmented vaginal repair of pelvic organ prolapse. Consensus of the 2nd IUGA grafts roundtable: optimizing safety and appropriateness of graft use in transvaginal pelvic reconstructive surgery. Int Urogynecol J. 2012;23(Suppl 1):33.

    Article  Google Scholar 

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Correspondence to Elizabeth Timbrook Brown M.D., M.P.H .

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Brown, E.T., Cohn, J.A., Kaufman, M.R., Reynolds, W.S., Dmochowski, R.R. (2017). Synthetic Midurethral Slings: Urinary Tract Sequelae. In: Goldman, H. (eds) Complications of Female Incontinence and Pelvic Reconstructive Surgery. Current Clinical Urology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-49855-3_16

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  • DOI: https://doi.org/10.1007/978-3-319-49855-3_16

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