Urethral reconstruction after erosion of slings in women

The purpose of this review is to summarize the recent peer review literature and provide expert opinion about the diagnosis and treatment of sling erosions.

The incidence of sling erosion depends partly on the composition of the sling. Synthetic slings, particularly those made of woven polyester and other tightly woven material erode 15 times more often than autologous, allograft and zenograft slings. The presenting symptoms for all types of sling erosions include urinary retention, urge and mixed incontinence, but synthetic sling erosions often present with additional symptoms, including vaginal discharge, vaginal pain/pressure, suprapubic pain, and recurrent urinary tract infection. The diagnosis is made by cystoscopy. For synthetic sling erosions, it is generally agreed that the entire sling and as much foreign material (bone anchors, screws and sutures) as possible should be removed and the urethra repaired. For non-synthetic sling erosions, incision or partial excision of the sling and urethral closure suffices. The success rate for urethral repair ranges from 89 to 100%, but unless an anti-incontinence procedure is performed concomitantly, the likelihood of postoperative incontinence ranges from 44 to 83%. When synchronous anti-incontinence surgery was performed the anatomical success rate was 96% and the continence rate 87%.

Erosions of urinary slings are rare, but synthetic slings erode 15 times more often than non-synthetic slings. The anatomical success rate is very high after a single operation, but unless a concomitant anti-incontinence operation is performed, the likelihood of postoperative sphincteric incontinence is very high.