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Urgency After a Sling: Review of the Management

  • Female Urology (K Kobashi, Section Editor)
  • Published:
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Abstract

Urinary urgency after synthetic sling surgery may be persistent urgency that preceded the surgery or de novo urgency that developed after surgery. Recent studies estimate a 40 % rate of persistent urgency after synthetic sling surgery in women with mixed urinary incontinence. Causes of de novo urgency after synthetic sling surgery include postoperative urinary tract infection (7.4–17.4 %), bladder outlet obstruction (1.9–19.7 %), perforation of the urinary tract (0.5–5 %), and idiopathic urgency (0–28 %). Given the temporal relationship of de novo urgency developing after surgery, until proven otherwise, one should assume that the etiology is obstruction. Evaluation includes a history and physical exam, urinalysis, and post-void residual. Cystoscopy and urodynamics may help rule out surgical complications. Management is based on the etiology of the urgency. Urinary tract perforation and bladder outlet obstruction are treated with surgical intervention. Idiopathic de novo or persistent urgency after synthetic sling surgery are treated similarly to idiopathic overactive bladder, with behavioral therapy as first-line treatment, antimuscarinics or beta-agonists as second-line therapy, and intravesical onabotulinumtoxinA or sacral neuromodulation as third-line therapy.

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Abbreviations

MUI:

Mixed urinary incontinence

SUI:

Stress urinary incontinence

UUI:

Urgency urinary incontinence

UTI:

Urinary Tract Infection

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20. This is the primary reference for current terminology with regard to voiding and pelvic floor dysfunction.

  2. 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(5):1906–14.

    Google Scholar 

  3. Katsumi HK, Rutman MP. Can we predict if overactive bladder symptoms will resolve after sling surgery in women with mixed urinary incontinence? Curr Urol Rep. 2010;11(5):328–37.

    Google Scholar 

  4. Albo ME, Litman HJ, Richter HE, et al. Treatment success of retropubic and transobturator mid urethral slings at 24 months. J Urol. 2012;188(6):2281–7. This is a prospective randomized controlled trial comparing outcomes of retropubic and transobturator mid-urethral slings in women with stress predominant urinary incontinence, with results at 24 months presented.

  5. Lee JK, Dwyer PL, Rosamilia A, et al. Persistence of urgency and urge urinary incontinence in women with mixed urinary symptoms after midurethral slings: a multivariate analysis. BJOG. 2011;118(7):798–805. This is a large retrospective cohort study of 1225 women with stress urinary incontinence and urgency or urgency incontinence, who underwent mid-urethral sling placement. With a mean follow-up of 4 years, rates of persistent urgency and urgency incontinence were assessed, as well as factors associated with persistent urgency and or incontinence.

  6. Patel BN, Kobashi KC, Staskin D. Iatrogenic obstruction after sling surgery. Nat Rev Urol. 2012. doi:10.1038/nrurol.2012.110.

  7. Swartz M, Ching C, Gill B, et al. Risk of infection after midurethral synthetic sling surgery: are postoperative antibiotics necessary? Urology. 2010;75(6):1305–8.

  8. Anger JT, Litwin MS, Wang Q, et al. Complications of sling surgery among female Medicare beneficiaries. Obstet Gynecol. 2007;109:707.

    Article  PubMed  Google Scholar 

  9. Lluel P, Duquenne C, Martin D. Experimental bladder instability following bladder outlet obstruction in the female rat. J Urol. 1998;160:2253.

    Article  PubMed  CAS  Google Scholar 

  10. Appell R. Guideline for the surgical management of female SUI 2009 Update.

  11. Daneshgari F, Kong W, Swartz M. Complications of mid urethral slings: important outcomes for future clinical trials. J Urol. 2008;180:1890.

    Article  PubMed  Google Scholar 

  12. Richter HE, Albo ME, Zyczynski HM, et al. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010;3629(22):2066–76.

    Google Scholar 

  13. Lee JK, Dwyer PL, Rosamilia A, et al. Which women develop urgency or urgency urinary incontinence following midurethral slings? Int Urogynecol J. 2013;24(1):47–54.

    Google Scholar 

  14. Sajadi KP, Vasavada SP. Overactive bladder after sling surgery. Curr Urol Rep. 2013;11(6):366–71.

    Google Scholar 

  15. Blaivas JG, Groutz A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn. 2000;19:553.

    Article  PubMed  CAS  Google Scholar 

  16. Groutz A, Blaivas JG, Chaikin DC. Bladder outlet obstruction in women: definition and characteristics. Neurourol Urodyn. 2000;19:213.

    Article  PubMed  CAS  Google Scholar 

  17. Rodrigues P, Hering F, Dias EC. Female obstruction after incontinence surgery may present different urodynamic patterns. Int Urogynecol J. 2013;24(2):331–6.

    Google Scholar 

  18. Starkman JS, Duffy III JW, Wolter CE, et al. The evolution of obstruction induced overactive bladder symptoms following urethrolysis for female bladder outlet obstruction. J Urol. 2008;179:1018.

    Article  PubMed  Google Scholar 

  19. Gormley EA, Lightner DJ, Burgio KL, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol. 2012;188(6):2455–63. These guidelines detail the evaluation for overactive bladder and the various treatment options available. Note that beta-agonists and botulinum toxin were approved by the FDA for idiopathic overactive bladder after the publication of these guidelines.

  20. Yoo EH, Kim D. Predictors of postoperative antimuscarinics in women with mixed urinary incontinence after transobturator surgery. Int Urogynecol J. 2013;24(3):401–6.

    Google Scholar 

  21. Opar A. Overactive bladder, under scrutiny, gets a new treatment. Nat Med. 2012;18(8):1159.

    Google Scholar 

  22. Dmochowski R, Chapple C, Nitti VW, et al. Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: a double-blind, placebo controlled, randomized, dose ranging trial. J Urol. 2010;184(6):2416–22. This important randomized controlled trial demonstrates the efficacy of botulinum toxin for idiopathic overactive bladder.

  23. Full Prescribing Information for OnabotulinumtoxinA.

  24. Sherman ND, Jamison MG, Webster GD, et al. Sacral neuromodulation for the treatment of refractory urinary urge incontinence after stress incontinence surgery. Am J Obstet Gynecol. 2005;193:2083.

    Article  PubMed  Google Scholar 

  25. Starkman JS, Duffy JW III, Wolter CE, et al. Refractory overactive bladder after urethrolysis for bladder outlet obstruction: management with sacral neuromodulation. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:277. This is the only study in the literature that assessed sacral neuromodulation for refractory overactive bladder after urethrolysis.

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Conflict of Interest

Dr. Nitya Abraham declares no potential conflicts of interest relevant to this article.

Dr. Sandip Vasavada is a consultant for Allergan and Medtronic.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave Q10-1, Cleveland, OH, 44195, USA

    Nitya Abraham & Sandip Vasavada

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  1. Nitya Abraham
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  2. Sandip Vasavada
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Correspondence to Sandip Vasavada.

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This article is part of the Topical Collection on Female Urology

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Abraham, N., Vasavada, S. Urgency After a Sling: Review of the Management. Curr Urol Rep 15, 400 (2014). https://doi.org/10.1007/s11934-014-0400-y

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  • DOI: https://doi.org/10.1007/s11934-014-0400-y

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