Abstract
Introduction and hypothesis
Persistent or recurrent stress urinary incontinence after midurethral sling placement is not uncommon. Treatment options include placement of a second midurethral sling, autologous fascial sling, retropubic urethropexy, or urethral bulking. Shortening of the sling by plication has also been suggested as an alternative option which may reduce operative time, cost, risk of trocar injury, and mesh burden. In this video, we aimed to demonstrate our technique and experience on sling plication.
Methods
The key steps of the procedure are as follows: (1) suburethral incision and sharp dissection to identify the sling; (2) mobilization of the suburethral portion of the sling; (3) plication with two interrupted, horizontal sutures placed 1 cm laterally on each side; (4) application of upward pressure while tying the sutures and tensioning the sling. In our experience, we have found this technique to be most successful for retropubic slings, especially when performed within 2–12 weeks of the initial surgery.
Conclusions
Sling plication is an effective and minimally invasive option to treat persistent stress urinary incontinence after failed midurethral sling procedures. It avoids additional mesh burden or more invasive retropubic surgery and should be offered as a treatment option for appropriately counseled patients.
References
Richter HE, Albo ME, Zyczynski HM, et al. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010;362:2066–76.
Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2017;7:Cd006375.
Gaddi A, Guaderrama N, Bassiouni N, et al. Repeat midurethral sling compared with urethral bulking for recurrent stress urinary incontinence. Obstet Gynecol. 2014;123:1207–12.
Bakali E, Buckley BS, Hilton P, et al. Treatment of recurrent stress urinary incontinence after failed minimally invasive synthetic suburethral tape surgery in women. Cochrane Database Syst Rev. 2013:Cd009407. https://pubmed.ncbi.nlm.nih.gov/23450602/.
Patterson D, Rajan S, Kohli N. Sling plication for recurrent stress urinary incontinence. Female Pelvic Med Reconstr Surg. 2010;16:307–9.
Maheshwari D, Jones K, Solomon E, et al. Sling Plication for Failed Midurethral Sling Procedures: A Case Series. Female Pelvic Med Reconstr Surg. 2019;25:e4–6.
Popiel P, Getaneh F, Yeh J, Rickey L, Bercik R, Harmanli O. Voided Volume for Assessment of Bladder Emptying After Female Pelvic Floor Surgery: A Randomized Control Trial. Female Pelvic Med Reconstr Surg. 2022. https://doi.org/10.1097/SPV.0000000000001230.
Miranne JM, Hampton BS, Sung VW. Midurethral sling shortening for persistent stress urinary incontinence. Int Urogynecol J. 2012;23:805–7.
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Swallow, C.H., Rickey, L.M. & Harmanli, O. Sling plication for persistent stress urinary incontinence after midurethral sling. Int Urogynecol J 34, 957–959 (2023). https://doi.org/10.1007/s00192-022-05379-z
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DOI: https://doi.org/10.1007/s00192-022-05379-z