Abstract
As many as 80 % of all women who complain of urine leakage will be diagnosed with stress urinary incontinence (SUI). As the population ages and SUI becomes more widespread, it is imperative to understand how to manage potential complications of the therapies used to treat this condition. As the mid-urethral sling has become the “gold standard” of SUI treatment, it is important to be aware of post-operative complications associated with this procedure. One significant complication of the MUS is subsequent urinary retention. In this review, we discuss the potential etiologies of post-sling urinary retention and outline the various modalities for achieving a timely and accurate diagnosis. We also emphasize the applications of various diagnostic tools, such as urodynamics, when evaluating patients with post-sling urinary retention. Lastly, various treatments for this complication are discussed. This chapter serves as a comprehensive overview of how to approach post-sling urinary retention, underlining the recent academic research contributions that have enhanced our understanding of how to manage this condition.
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Milsom IAD, Lapitan MC, Nelson R, Sillen U, Thom DH. Epidemiology of urinary (UI) and faecal (FI) incontinence and pelvic organ prolapse (POP). Committe 1. International Continence Society 2009.
Ogah J, Cody JD, Rogerson L. Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2009 2009;4:CD006375. doi:10.1002/14651858.CD006375.pub2.
Nager C, Tulikangas P, Miller D, Rovner E, Goldman H. Position statement on mesh midurethral slings for stress urinary incontinence. Female Pelvic Med Reconstr surgery. 2014;20:123–5. Joint position statement issues by AUGS/SUFU, which reiterates the overall safety and efficacy of MUS as the current “gold standard” for treatment of SUI.
Dobberfuhl AD, De EJ. Female stress urinary incontinence and the mid-urethral sling: is obstruction necessary to achieve dryness? World J Urol. 2015;33:1243–50.
Brubaker L, Norton PA, Albo ME, et al. Adverse events over two years after retropubic or transobturator midurethral sling surgery: findings from the Trial of Midurethral Slings (TOMUS) study. Am J Obstet Gynecol. 2011;205:498 e1-6.
Clemons JL, Weinstein M, Guess MK, et al. Impact of the 2011 FDA transvaginal mesh safety update on AUGS members’ use of synthetic mesh and biologic grafts in pelvic reconstructive surgery. Female Pelvic Med Reconstr Surg. 2013;19:191–8.
Dunn Jr JS, Bent AE, Ellerkman RM, Nihira MA, Melick CF. Voiding dysfunction after surgery for stress incontinence: literature review and survey results. Int Urogynecol J Pelvic Floor Dysfunct. 2004;15:25–31. discussion.
Welk B, AL-Hothi H, Winick-Ng J. Removal or revision of vaginal mesh used for the treatment of stress urinary incontinence. JAMA Surg. 2015;150(12):1167–75. Largest retrospective cohort study to date looking at composite outcome of surgical procedures related to removal or revision of MUS with relation to surgeon level of experience and specialty.
Leach GD, Appel R, Blaivas J, Hadley R, Luber K, Mostwin J, et al. Female stress urinary incontinence clinical guidelines panel report on surgical management of female stress urinary incontinence. J Urol. 1997;158:875–80.
Dmochowski RR, Blaivas JM, Gormley EA, et al. Update of AUA guideline on the surgical management of female stress urinary incontinence. J Urol. 2010;183:1906–14.
Blaivas JG, Purohit RS, Benedon MS, et al. Safety considerations for synthetic sling surgery. Nat Rev Urol. 2015;12:481–509. This notable review discusses at length the potential adverse outcomes of synthetic sling surgery.
Albo M, Richter H, Brubaker L, Norton P, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med. 2007;356:2143–55.
Daneshgari F, Kong W, Swartz M. Complications of mid urethral slings: important outcomes for future clinical trials. J Urol. 2008;180:1890–7.
Latthe PM, Foon R, Toozs-Hobson P. Transobturator and retropubic tape procedures in stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications. BJOG. 2007;114:522–31.
Richter HE, Albo ME, Zyczynski HM, et al. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010;362:2066–76.
Nguyen JN, Jakus-Waldman SM, Walter AJ, White T, Menefee SA. Perioperative complications and reoperations after incontinence and prolapse surgeries using prosthetic implants. Obstet Gynecol. 2012;119:539–46.
Jonsson Funk M, Siddiqui NY, Pate V, Amundsen CL, Wu JM. Sling revision/removal for mesh erosion and urinary retention: long-term risk and predictors. Am J Obstet Gynecol. 2013;208:73 e1-7.
Patel BN, Kobashi KC, Staskin D. Iatrogenic obstruction after sling surgery. Nat Rev Urol. 2012;9:429–34.
Tse V, Chan L. Outlet obstruction after sling surgery. BJU Int. 2011;108:24–8.
Nitti VW, Tu LM, Gitlin J. Diagnosing bladder outlet obstruction in women. J Urol. 1999;161:1535–40.
Aponte MM, Shah SR, Hickling D, Brucker BM, Rosenblum N, Nitti VW. The utility of urodynamics in clinically suspected obstruction after anti-incontinence surgery in women. J Urol. 2013;190:598–602.
Rodrigues P, Hering F, Dias EC. Female obstruction after incontinence surgery may present different urodynamic patterns. Int Urogynecol J. 2013;24:331–6.
Gammie A, Kirschner-Hermanns R, Rademakers K. Evaluation of obstructed voiding in the female: how close are we to a definition? Curr Opin Urol. 2015;25:292–5.
Brucker BM, Shah S, Mitchell S, et al. Comparison of urodynamic findings in women with anatomical versus functional bladder outlet obstruction. Female Pelvic Med Reconstr Surg. 2013;19:46–50.
Karram M. Complications and untoward effects of the tension-free vaginal tape procedure. Obstet Gynecol. 2003;101:929–32.
Klutke C, Siegel S, Carlin B, et al. Urinary retention after tension-free vaginal tape procedure: incidence and treatment. Urology. 2001;58:697–701.
Price N, Slack A, Khong SY, Currie I, Jackson S. The benefit of early mobilisation of tension-free vaginal tape in the treatment of post-operative voiding dysfunction. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:855–8.
Nguyen JN. Tape mobilization for urinary retention after tension-free vaginal tape procedures. Urology. 2005;66:523.
Rautenberg O, Kociszewski J, Welter J, Kuszka A, Eberhard J, Viereck V. Ultrasound and early tape mobilization—a practical solution for treating postoperative voiding dysfunction. Neurourol Urodyn. 2014;33:1147–51.
Chang WC, Sheu BC, Huang SC, et al. Postoperative transvaginal tape mobilization in preventing voiding difficulty after tension-free vaginal tape procedures. Int Urogynecol J. 2010;21:229–33.
Nitti VW et al. Early results of pubovaginal sling lysis by midline sling incision. Urology. 2002;59(1):47–51.
Moore CK, Goldman HB. Simple sling incision for the treatment of iatrogenic bladder outlet obstruction. Int Urogynecol J. 2013;24:2145–6.
Scarpero HM et al. Repeat urethrolysis after failed urethrolysis for iatrogenic obstruction. J Urol. 2003;169(3):1013–6.
Van den Broeck T, De Ridder D, Van der Aa F. The value of surgical release after obstructive anti-incontinence surgery: an aid for clinical decision making. Neurourol Urodyn. 2015;34:736–40.
Clifton MM, Linder BJ, Lightner DJ, Elliott DS. Risk of repeat anti-incontinence surgery following sling release: a review of 93 cases. J Urol. 2014;191:710–4.
Leng W, Davies B, Tarin T, Sweeney D, Chancellor M. Delayed treatment of bladder outlet obstruction after sling surgery: association with irreversible bladder dysfunction. J Urol. 2004;172:1379–81.
Coskun B, et al. Urodynamics for incontinence after midurethral sling removal. Neurourol Urodyn. 2015. doi:10.1002/nau.22831.
Zivanovic I, et al. Urethral bulking for recurrent stress urinary incontinence after midurethral sling failure. Neurourol Urodyn. 2016. doi:10.1002/nau.23007.
Hashim H, Terry TR. Management of recurrent stress urinary incontinence and urinary retention following midurethral sling insertion in women. Ann R Coll Surg Engl. 2012;94(7):517–22.
Verbrugghe A et al. A repeat mid-urethral sling as valuable treatment for persistent or recurrent stress urinary incontinence. Int Urogynecol J. 2013;24(6):999–1004.
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Dominique R. Malacarne and Victor W. Nitti each declare no potential conflicts of interest.
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This article is part of the Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction
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Malacarne, D.R., Nitti, V.W. Post-Sling Urinary Retention in Women. Curr Urol Rep 17, 83 (2016). https://doi.org/10.1007/s11934-016-0639-6
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DOI: https://doi.org/10.1007/s11934-016-0639-6