Adult urologyEarly results of pubovaginal sling lysis by midline sling incision
Section snippets
Material and methods
We reviewed the charts of 19 women who underwent transvaginal sling incision for obstruction after pubovaginal sling placement for stress incontinence. All patients had undergone a complete history taking, physical examination, postvoid residual urine determination, multichannel videourodynamic studies, and cystoscopy. All were deemed to have obstruction on the basis of a combination of clinical (history, physical examination findings, preoperative voiding status), urodynamic (relatively high
Results
The mean patient age was 57 years (range 35 to 75). All patients reported “normal emptying” before sling surgery. Fifteen women (79%) had an autologous fascial sling, three (16%) an allographic fascia lata sling, and one (5%) a synthetic (polypropylene) sling. The sling was identified and incised in all patients by the described technique. The mean time to takedown of the sling was 10.6 months (range 3 to 72).
Twelve women (63%) presented with partial or complete urinary retention and were
Comment
Suburethral slings are now widely accepted as both primary and secondary treatment for all types of stress incontinence. Numerous techniques have been described, and common sling materials include autologous and allograft fascia and synthetic mesh. Successful placement of a suburethral sling requires a balance between providing support and avoiding obstruction. To date, no standardized technique for determining the ideal sling tension exists, but most experts recommend that the sling be tied
Conclusions
Transvaginal sling incision appears to be a safe and efficacious method to treat obstruction after pubovaginal sling placement. It is technically easier than formal urethrolysis and has a low morbidity. The success rates and recurrent stress incontinence rates compare favorably with formal urethrolysis. It should be considered as a first-line treatment of an obstructing pubovaginal sling.
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Cited by (96)
Synthetic Midurethral Slings: Roles, Outcomes, and Complications
2019, Urologic Clinics of North AmericaReply by the Authors
2018, UrologyManagement of Urinary Incontinence Following Suburethral Sling Removal
2017, Journal of UrologyCitation Excerpt :However, in contrast to our study in which all patients underwent suburethral sling removal, 52% of the patients in the series by Clifton et al underwent sling incision compared to partial sling resection in 43% and complete sling removal in 5%. Nitti et al reported comparable risks of incontinence after sling incision vs formal urethrolysis.11 Clifton et al similarly found no significant difference in the risk of a repeat anti-incontinence procedure after partial or complete sling removal compared to sling incision.13
Long-term functional results after unilateral mid-urethral sling transection for voiding dysfunction
2016, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :Not all patients had suitable FRM, but the significance level makes the extrapolation to most patients credible. The success rate of MUS transection or urethrolysis varies considerably depending on the end-point used by the study, ranging from 65% to 100% success [1,6,8,16]. Success is usually defined as the ability to void spontaneously with small residual urine, and resolution of voiding and storage symptoms [6].
Urgency Incontinence before and after Revision of a Synthetic Mid Urethral Sling
2016, Journal of Urology