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Lateral cut as management of late voiding dysfunction syndrome post sling: ‘more than a cut’ - video article

Abstract

Introduction and hypothesis

The mid-urethral sling (MUS) is considered the gold standard for stress urinary incontinence (SUI). Nevertheless, this procedure is not excluded from postsurgical complications, which can be challenging for most clinicians. Hence, one of the main concerns about this procedure is late postoperative voiding dysfunction (LDS), defined as obstructive symptoms 6 weeks after surgery. Primary medical management regularly includes expectant management and rehabilitation, including the mid-urethral cut sling (MUCS) as an alternative when it fails. This video provides an anatomical illustration and detailed description of the surgical steps of the J-cut of the lateral sling.

Materials and methods

We set up a step-by-step surgical process and provided some advice for MUCS in a video; this material included how to position the sling, dissect, isolate the synthetic material, release adhesions and make a lateral cut of the MUS. Additionally, a case series of 30 patients from our institution is described to confirm the effectiveness of MUCS to manage delayed voiding dysfunction syndrome.

Results

MUCS in LDS was beneficial for our patients. Obstructive symptoms improved clinically from 75% to 100%, and urgency-related symptoms decreased from 57.9% to 26.3%, evidencing 20% SUI post-MUCS surgery.

Conclusions

The lateral cut of the mid-urethral tape should be considered a surgical alternative for the resolution of post-sling late voiding dysfunction syndrome in patients who do not improve with expectant management.

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Fig. 1

Abbreviations

MUS:

mid-urethral sling

TVT-R:

retropubic suburethral tape

TVT-O:

transobturator suburethral tape

SUI:

stress urinary incontinence

MUCS:

mid-urethral cutting sling

VD:

voiding dysfunction

LDS:

late voiding dysfunction syndrome post sling

J-cut:

lateral “J” cut

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Affiliations

Authors

Contributions

J. Solarte: Protocol, Data collection, Project development, Data analysis, Manuscript writing, Editing.

CA Díaz: Protocol, Project development, Data analysis, Manuscript writing.

CA Beltran: Data analysis, Editing.

Corresponding author

Correspondence to Juan D. Solarte.

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Solarte, J.D., Diaz, C.A. & Beltran, C.A. Lateral cut as management of late voiding dysfunction syndrome post sling: ‘more than a cut’ - video article. Int Urogynecol J (2021). https://doi.org/10.1007/s00192-021-04993-7

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Keywords

  • Sling incision
  • Voiding dysfunction
  • Urethrolysis