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Outcome of surgical management for midurethral sling complications: a multicentre retrospective cohort study

  • Victoria KershawEmail author
  • Rachel Nicholson
  • Paul Ballard
  • Aethele Khunda
  • Santhosh Puthuraya
  • Elaine Gouk
Original Article

Abstract

Introduction and hypothesis

Suspension of midurethral sling (MUS) surgery in the UK has led to a call for further evidence regarding long-term morbidity and the efficacy of treatments when mesh complications are encountered. We reviewed how many patients who underwent MUS surgery in Teesside, UK, returned to theatre due to a complication and what the outcomes were following this surgical intervention.

Methods

All patients coded to have undergone an MUS procedure between 1 January 2010 and 31 December 2014 in Teesside were reviewed retrospectively (n = 924). Case notes were analysed for patients who returned to theatre up until December 2017 due to complications related to their original MUS.

Results

Seventy-one of 924 (7.7%) women returned to theatre for some form of surgical intervention. There was a statistically significant difference in return-to-theatre rate between the transobturator and retropubic approach groups (63/661; 9.5%; confidence interval (CI) 7.3–11.8% v 8/263; 3.0%; CI 0.96%, 5.1%, odds ratio (OR) 3.35, p = 0.001); 2.8% (26/924) underwent shortening, reburying, incision or MUS excision; 1.0% (9/924) underwent steroid injection along the MUS tract; 1.7% (16/924) underwent surgical treatment of detrusor overactivity; 3.0% (28/924) required further stress incontinence surgery. The risk of unresolved chronic pain post-MUS surgery following treatment of complications was 0.2% (2/924).

Conclusions

Our results show a reassuringly low rate of mesh removal following MUS surgery. Furthermore, outcomes were good following surgical management of MUS complications. We advocate compulsory registration of all MUS procedures, follow-up data and complications to provide robust long-term evidence for the future.

Keywords

Complication Midurethral sling Mesh Stress incontinence TVT  TOT 

Notes

Compliance with ethical standards

Conflicts of interest

V Kershaw: None.

R Nicholson: None.

P Ballard: None.

A Khunda: Received an educational travel grant from Medtronic plc.

S Puthuraya: None.

E Gouk: None.

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Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.South Tees Hospitals NHS Foundation Trust, James Cook University HospitalMiddlesbroughUK
  2. 2.North Tees & Hartlepool NHS Foundation TrustStockton on TeesUK

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