Mini-slings can cause complications

Single-incision mini-slings (SIMS) have been advocated to avoid the complications of transobturator and retropubic midurethral slings. We present a series of SIMS complications and their outcome after vaginal removal at a tertiary care center.

Following Institutional Review Board approval, a prospective database of consecutive women who underwent SIMS removal for complications and had a minimum follow-up of 6 months was reviewed. Patient-reported outcomes were assessed by main symptom category. In addition, an ideal outcome or cure was defined as continent, pain-free, sexually active if active preoperatively, and not requiring additional medical or surgical therapy.

Of 23 women, 17 met inclusion criteria. Presenting symptoms were varied but dominated by incontinence (14), pelvic pain (11), dyspareunia (10), and obstructive urinary symptoms/urinary retention (5), with 76 % presenting with more than one complaint. Type of SIMS included MiniArc™ (11), Solyx™ (4), and TVT-Secur™ (2). At a mean follow-up of 17 ± 9 (range 7-44) months after SIMS removal, six (35 %) women were cured of their presenting complaint. Among the 11 women with pelvic pain, 6 had resolution of pain, 2 improvement, and 3 persistent pain. Six of seven women who were sexually active beforehand resumed sexual activity. Dyspareunia persisted in three women. Of 14 with incontinence, 8 had cure or improvement, and obstructive symptoms resolved in 4 of 5.

This series outlines several complications with SIMS, similar to what has been reported with other suburethral synthetic tapes. Therefore, caution is required and patient counseling is important.