IS IT THE MATERIAL OR SURGEON? A RE-EXAMINATION OF MID-URETHRAL SLING COMPLICATIONS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II (PD27)1 Apr 2020PD27-02 IS IT THE MATERIAL OR SURGEON? A RE-EXAMINATION OF MID-URETHRAL SLING COMPLICATIONS Caitlin Lim*, Nicholas Major, Andrew Margules, Alyssa Greiman, Yu Zheng, Hailey Silverii, Ross Rames, Lindsey Cox, and Eric Rovner Caitlin Lim*Caitlin Lim* More articles by this author , Nicholas MajorNicholas Major More articles by this author , Andrew MargulesAndrew Margules More articles by this author , Alyssa GreimanAlyssa Greiman More articles by this author , Yu ZhengYu Zheng More articles by this author , Hailey SilveriiHailey Silverii More articles by this author , Ross RamesRoss Rames More articles by this author , Lindsey CoxLindsey Cox More articles by this author , and Eric RovnerEric Rovner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000884.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Synthetic mid-urethral slings (MUS) have been widely used for the treatment of stress urinary incontinence (SUI) for over two decades. However, obstruction, persistent or recurrent incontinence, pain, and mesh erosion are known complications that may necessitate removal or revision. Such problems are often attributed to the inherent properties of the mesh material, while limited attention has been directed towards other factors, including surgical technique. We sought to identify potential technical factors that lead to subsequent sling revision procedures. METHODS: Following IRB approval, a retrospective chart review was performed of all women who had undergone revision or removal of a synthetic MUS at our institution over an 11 year period. In addition to baseline demographics and indications for re-operation, we reviewed operative reports of each revision surgery to identify anatomic location, depth, and apparent tension of the sling. Additionally, a critical review of the original implanting surgeon’s operative and peri-operative documentation, when available, was performed to identify any evidence of technical factors potentially contributing to the sling complications. RESULTS: Between 2008 and 2019, 298 women underwent re-operation on a previously placed synthetic MUS. Prior operative reports were available for 276 (92.6%) women. The most common indications for re-operation were obstruction (60.8%), mesh erosion (30.9%), UTI (18.7%), and pain (37.8%). In 184 women (66.6%) there was either an intraoperative finding during the revision surgery to which the complication could be attributed, or there was documentation suggestive of a contributing technical factor during the initial sling placement procedure. Among these 184 women, 120 (65.2%) were noted to have their sling either too proximal or distal to the mid urethra, 77 (41.8%) had over-suspension, and 58 women (31.5%) had slings placed too deep in the periurethral fascia. It was noted that 10 women, either with obstruction or erosion, had an identified urinary tract injury in the operative note from their initial MUS implant procedure. CONCLUSIONS: Operative re-exploration of MUS complications often reveal evidence that the initial MUS implantation was technically suboptimal. Such findings suggest that intraoperative surgical technique is a critically important factor contributing to postoperative complications in MUS surgery. This underscores the importance of proper surgical training, and adherence to surgical principles during placement of a synthetic MUS. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e549-e549 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Caitlin Lim* More articles by this author Nicholas Major More articles by this author Andrew Margules More articles by this author Alyssa Greiman More articles by this author Yu Zheng More articles by this author Hailey Silverii More articles by this author Ross Rames More articles by this author Lindsey Cox More articles by this author Eric Rovner More articles by this author Expand All Advertisement PDF downloadLoading ...