Overactive bladder after sling surgery

Midurethral sling surgery has become the new gold standard for the management of stress urinary incontinence. A significant number of patients will have preoperative symptoms of overactive bladder (OAB), including urgency, frequency, nocturia, and/or urgency urinary incontinence; however, 5% to 25% of women will report persistent, worsening, or de novo OAB after sling surgery. Some cases of OAB after sling surgery are known complications that should be recognized promptly and corrected, including urinary tract infection, urinary tract foreign body, and bladder outlet obstruction. For the remainder, the diagnosis and management of idiopathic postoperative OAB can be complicated. Preoperative clinical and urodynamic factors, as well as the choice of sling, may be helpful in predicting these patients and counseling them appropriately. When standard conservative therapy for OAB fails, sling incision, sacral neuromodulation, and botulinum toxin may be useful adjuncts.