Abstract
Purposes
Midurethral synthetic sling (MUS) placement via either the retropubic or transobturator route is the standard surgical procedure for women with stress urinary incontinence. However, a small portion of patients experienced voiding dysfunction after the surgery, which was debilitating to their quality of life. Our study was aimed at demonstrating the effectiveness of the unilateral sling cut down for post-midurethral sling (MUS) voiding dysfunction and, secondarily, at evaluating the changes in urodynamic parameters.
Methods
We retrospectively reviewed the charts of patients who received unilateral midurethral sling cut down for voiding dysfunction after an MUS procedure. The cut-down procedures were performed at the urethral meatus, in the 9 or 3 o’clock direction. Preoperative and postoperative subjective and objective parameters were compared to evaluate the outcome of the cut-down procedures.
Results
We selected 15 patients who underwent unilateral MUS cut down for voiding dysfunction after anti-incontinence procedures with various MUSs. The cut-down procedures were performed at a median interval of 7.1 months after sling insertion. The subjective results of the Patient Global Impression of Improvement (PGI-I) after the cut-down procedure showed an overall satisfaction of 93.33%. After the cut-down procedure, the median flow rate increased from 14.8 to 22 ml/s (P > 0.05), and the post-void residual urine volume decreased from 193.5 to 35.0 ml (P < 0.05). All patients attained continence after the cut-down procedures.
Conclusions
Unilateral MUS cut down is effective in the management of voiding dysfunction after anti-incontinence surgery, with a low risk of recurrence of urinary incontinence.
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Acknowledgements
We thank CMRPG8G0122 for the support provided for this study. We thank the Biostatistics Center, Kaohsiung Chang Gung Memorial Hospital, for conducting the statistical work.
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Ngo, Y., Huang, KH., Kung, FT. et al. The effects of “unilateral midurethral sling cut down” in women with voiding dysfunctions after anti-incontinence surgery. Int Urol Nephrol 51, 1501–1506 (2019). https://doi.org/10.1007/s11255-019-02219-w
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DOI: https://doi.org/10.1007/s11255-019-02219-w