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Comparison of early loosening vs delayed section of mid-urethral slings for postoperative voiding dysfunction

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Abstract

Introduction and hypothesis

Bladder outlet obstruction (BOO) is a common occurrence after midurethral sling (MUS) insertion and can result in acute or chronic urinary retention or de novo lower urinary tract symptoms (LUTS). However, the management of BOO after MUS is not standardised. The objective of this study was to compare two therapeutic strategies for suspected BOO after MUS.

Methods

Patients who had surgical revision for voiding dysfunction with a post-void residual (PVR) ≥100 ml after MUS in five centres between 2005 and 2020 were included in a retrospective study. Patients were divided into two groups: early sling loosening (EL) vs delayed section/excision of the sling (DS).

Results

Seventy patients were included: 38 in the EL group and 32 in the DS group. The postoperative complication rate was comparable in both groups (10.5% vs 12.5%; p = 0.99). At 3 months, the rate of withdrawal from self-catheterisation was similar in the two groups (92.1% vs 100%; p = 0.25) as was the PVR (57.5 vs 63.5 ml; p = 0.09). After a median follow-up of 9 months, there were significantly more patients with resolved voiding dysfunction in the EL group (63.2% vs 31.3%; p = 0.01). The rate of persistent/recurrent stress urinary incontinence (SUI) was higher in the DS group (21% vs 43.7%; p = 0.04). In multivariate analysis, the main predictive factor of recurrent SUI was DS (OR 2.87, 95% CI 1.01–8.60, p = 0.048).

Conclusions

Early loosening of MUS in the case of postoperative voiding dysfunction offers better efficacy than DS of the sling, with a lower risk of recurrent/persistent SUI.

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Abbreviations

BOO:

Bladder outlet obstruction

CIC:

Clean intermittent catheterisation

DS:

Delayed section/partial section

EL:

Early loosening

LUTS:

Lower urinary tract symptoms

MUS:

Midurethral sling

PVR:

Post-void residual

Qmax:

Maximum urinary flow rate

SUI:

Stress urinary incontinence

References

  1. Aoki Y, Brown HW, Brubaker L, Cornu JN, Daly JO, Cartwright R. Urinary incontinence in women. Nat Rev Dis Primer. 2017;3:17042.

    Article  Google Scholar 

  2. Kuhlmann-Capek MJ, Kilic GS, Shah AB, Diken ZM, Snyder RR, Phelps JY. Enmeshed in controversy: use of vaginal mesh in the current medicolegal environment. Female Pelvic Med Reconstr Surg. 2015;21(5):241–3.

    Article  PubMed  Google Scholar 

  3. Haylen BT, Lee JKS, Sivagnanam V, Cross A. What if there were no tapes? Neurourol Urodyn. 2018;37(6):2026–34.

    Article  PubMed  Google Scholar 

  4. Hermieu N, Hermieu J-F, Schoentgen N, et al. Évolution des pratiques après l’arrêté encadrant les bandelettes sous-urétrales : résultats d’une enquête nationale. Prog Urol. 2021. https://doi.org/10.1016/j.purol.2021.03.003.

    Article  PubMed  Google Scholar 

  5. Ngo YG, Huang K-H, Kung F-T, et al. The effects of “unilateral midurethral sling cut down” in women with voiding dysfunctions after anti-incontinence surgery. Int Urol Nephrol. 2019;51(9):1501–6.

    Article  PubMed  Google Scholar 

  6. Moksnes LR, Svenningsen R, Schiøtz HA, Moe K, Staff AC, Kulseng-Hanssen S. Sling mobilization in the management of urinary retention after mid-urethral sling surgery. Neurourol Urodyn. 2017;36(4):1091–6.

    Article  PubMed  Google Scholar 

  7. Fritel X, Campagne-Loiseau S, Cosson M, et al. Complications after pelvic floor repair surgery (with and without mesh): short-term incidence after 1873 inclusions in the French VIGI-MESH registry. BJOG. 2020;127(1):88–97.

    Article  CAS  PubMed  Google Scholar 

  8. Nguyen JK, Glowacki CA, Bhatia NN. Survey of voiding dysfunction and urinary retention after anti-incontinence procedures. Obstet Gynecol. 2001;98(6):1011–7.

    CAS  PubMed  Google Scholar 

  9. Brennand EA, Tang S, Birch C, Robert M, Kim-Fine S. Early voiding dysfunction after midurethral sling surgery: comparison of two management approaches. Int Urogynecol J. 2017;28(10):1515–26.

    Article  PubMed  Google Scholar 

  10. Petros P. A constricted midurethral sling needs loosening within 48–72 hours. Int Urogynecol J. 2018;29(4):609–10.

    Article  PubMed  Google Scholar 

  11. Bazi T, Kerkhof MH, Takahashi SI, Abdel-Fattah M, IUGA Research and Development Committee. Management of post-midurethral sling voiding dysfunction. International Urogynecological Association research and development committee opinion. Int Urogynecol J. 2018;29(1):23–28.

    Article  PubMed  Google Scholar 

  12. 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(7):1147–51.

    Article  PubMed  Google Scholar 

  13. Glavind K, Shim S. Incidence and treatment of postoperative voiding dysfunction after the tension-free vaginal tape procedure. Int Urogynecol J. 2015;26(11):1657–60.

    Article  PubMed  Google Scholar 

  14. Abraham N, Makovey I, King A, Goldman HB, Vasavada S. The effect of time to release of an obstructing synthetic mid-urethral sling on repeat surgery for stress urinary incontinence. Neurourol Urodyn. 2017;36(2):349–53.

    Article  PubMed  Google Scholar 

  15. Bailey C, Matharu G. Conservative management as an initial approach for post-operative voiding dysfunction. Eur J Obstet Gynecol Reprod Biol. 2012;160(1):106–9.

    Article  PubMed  Google Scholar 

  16. Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Elbadawi A, Yalla SV, Resnick NM. Structural basis of geriatric voiding dysfunction. IV. Bladder outlet obstruction. J Urol. 1993;150(5 Pt 2):1681–95.

    Article  CAS  PubMed  Google Scholar 

  18. Brading AF. A myogenic basis for the overactive bladder. Urology. 1997;50(6A Suppl):57–67; discussion 68–73. https://doi.org/10.1016/s0090-4295(97)00591-8

    Article  CAS  PubMed  Google Scholar 

  19. Thomas AW, Cannon A, Bartlett E, Ellis-Jones J, Abrams P. The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow-up of untreated bladder outlet obstruction. BJU Int. 2005;96(9):1301–6.

    Article  PubMed  Google Scholar 

  20. Guven A, Onal B, Kalorin C, et al. Long term partial bladder outlet obstruction induced contractile dysfunction in male rabbits: a role for Rho-kinase. Neurourol Urodyn. 2007;26(7):1043–9.

    Article  CAS  PubMed  Google Scholar 

  21. Shaw J, Wohlrab K, Rardin C. Recurrence of stress urinary incontinence after midurethral sling revision: a retrospective cohort study. Female Pelvic Med Reconstr Surg. 2017;23(3):184–7.

    Article  PubMed  Google Scholar 

  22. Mishra VC, Mishra N, Karim OMA, Motiwala HG. Voiding dysfunction after tension-free vaginal tape: a conservative approach is often successful. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(3):210–4.

    Article  PubMed  Google Scholar 

  23. Paick J-S, Ku JH, Shin JW, Oh S-J, Kim SW. Complications associated with the tension-free vaginal tape procedure: the Korean experience. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(3):215–9.

    Article  PubMed  Google Scholar 

  24. Kim JW, Moon DG, Shin JH, Bae JH, Lee JG, Oh MM. Predictors of voiding dysfunction after mid-urethral sling surgery for stress urinary incontinence. Int Neurourol J. 2012;16(1):30–6.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Neuman M. Post tension-free vaginal tape voiding difficulties: prevention and management. J Pelvic Med Surg. 2004;10(1):19–21.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Human Reproduction, University of Rennes, Rennes, France

    Marion Pinsard, Sonia Guerin, Jean-Philippe Harlicot, Vincent Lavoue, Jean Leveque & Krystel Nyangoh Timoh

  2. Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Service de Gynécologie & Obstétrique, 78303, Poissy CEDEX, France

    Arnaud Fauconnier

  3. Université Paris-Saclay, UVSQ, 78180, Montigny-le-Bretonneux, France

    Arnaud Fauconnier

  4. Department of Obstetrics and Gynecology, Saint Grégoire Private Hospital, Saint Grégoire, France

    François D’Halluin

  5. Department of Obstetrics and Gynecology, Clinique La Sagesse, Rennes, France

    Pierre-Louis Broux

  6. Department of Urology, University of Rennes, Rennes, France

    Anis Gasmi, Andrea Manunta & Benoit Peyronnet

  7. Service d’Urologie, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35000, Rennes, France

    Benoit Peyronnet

Authors
  1. Marion Pinsard
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  2. Arnaud Fauconnier
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  4. Pierre-Louis Broux
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  12. Benoit Peyronnet
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Contributions

Marion Pinsard collected and analysed data and wrote the manuscript; Sonia Guérin and Anis Gasmi helped with data collection; Arnaud Fauconnier, François D’Halluin, Pierre-Louis Broux, Jean-Philippe Harlicot, Vincent Lavoué, Jean Levêque, Andrea Manunta and Krystel Nyangoh Timoh helped to design and conduct the study, and have read and approved the final report; Benoît Peyronnet developed the study concept, made statistics and participated in analysing all the data and writing the article.

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Correspondence to Benoit Peyronnet.

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Pinsard, M., Fauconnier, A., D’Halluin, F. et al. Comparison of early loosening vs delayed section of mid-urethral slings for postoperative voiding dysfunction. Int Urogynecol J 34, 675–681 (2023). https://doi.org/10.1007/s00192-022-05095-8

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  • DOI: https://doi.org/10.1007/s00192-022-05095-8

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