18: Incontinence rates after midurtheral sling revision for vaginal exposure or pain

We describe the rate of postoperative urinary incontinence (UI) after midurethral sling (MUS) revision for the indication of vaginal mesh exposure and vaginal pain, as well as postoperative complaints of urgency and pain. This is an IRB approved retrospective cohort of patients who had undergone a vaginal synthetic mesh MUS sling revision at our institution from May 2004 to May 2014 for the indication of mesh exposure or pain. The preoperative indication for revision was collected as well as baseline characteristics including preoperative complaints of UI, pain and urgency. The type of sling revision was then separated into partial excision or complete excision. A partial removal of the sling was defined as removing only the portion of the sling that was exposed or causing pain. A complete removal of the sling was defined as both arms of the sling dissected out to bilateral pubic rami and then excised. Postoperative visits were reviewed for subjective complaints of UI, pain and urgency at short term (= 16 weeks) and long term (>16 weeks) visits. The primary outcome of the study was recurrent rate of UI and the secondary outcomes were postoperative pain and urgency rates. Statistics were performed using Stata Statistical Software: Release 13. (StataCorp. 2013. College Station, TX). Ninety-four patients were identified to have undergone vaginal MUS removal for the indication of mesh exposure; 36 (38%) were partial and 58 (62%) were complete removal of the sling material. One hundred fifty-one patients were identified to have vaginal sling removal for the indication of pain; 25 (17%) had partial and 126 (83%) had complete removal of their sling. All patients had a short term follow up visit with a median follow up time of 5.9 weeks and 69% patients had a long term follow up visit with mean follow up time of 29 weeks. No difference was seen in preoperative complaints of UI, urgency or pain in either groups between the revision types performed. In the patients with the indication of mesh exposure with no preoperative complaint of UI, there is a significant increase in postoperative UI with complete excision versus partial excision of the sling at short term and long term follow up. In the patients with the indication of pain, a trend toward increase in newly reported postoperative UI with complete excision of the sling was seen at long term follow up, but this was not significant (Table 1). In the pain patients, 72% of partial excision and 76% of complete excision patients had resolution of their pain post operatively. No difference was seen in postoperative complaints of urgency or pain in either groups between the revision types performed. There is a difference in incontinence rates after partial and complete vaginal excision of MUS for the indication of mesh exposure and possibly for the indication of pain, with complete excision bearing the highest risk of postoperative incontinence in this cohort.