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Updated: Mar 23, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Long-Term Outcomes After Repair of Transurethral Perforation of Midurethral Sling
1From the *Virginia Commonwealth University School of Medicine; and †Virginia Urology Center for Incontinence and Pelvic Floor Reconstruction, Richmond, VA.
Objectives:
The literature lacks long-term evaluation of outcomes after repair of transurethral midurethral sling (MUS) perforation.
Methods:
We prospectively followed 5 patients undergoing repair of urethral perforation (International Continence Society-International Urogynecological Association classification 4B) after MUS (mean follow-up, 54 months). Outcomes assessment was composed of validated measures of urinary (International Consultation on Incontinence Questionnaire [ICIQ]-Female Lower Urinary Tract Symptoms), vaginal (ICIQ-Vaginal Symptoms), and quality of life (Incontinence Impact Questionnaire, Short Form) symptoms.
Results:
Five patients underwent MUS (4 transobturator, 1 retropubic) with a mean of 41 months before referral. Primary referring complaints composed of hematuria (2), weak stream (2), and urgency (1). All but 1 patient reported transient urinary retention requiring catheterization after initial sling placement. Each patient underwent transvaginal sling excision and repair of urethral injury. Four of 5 patients experienced persistent postoperative stress urinary incontinence. Before final assessment, further treatment included observation, physical therapy, and autologous fascial sling in 1, 2, and 2 patients, respectively. ICIQ-Female Lower Urinary Tract Symptoms, ICIQ-Vaginal Symptoms, and Incontinence Impact Questionnaire, Short Form, assessment failed to demonstrate statistically significant improvements in comparison of baseline and multiple time point (6-week, 12-month, 54-month) assessments during long-term follow-up (P > 0.05).
Conclusions:
Urethral perforation represents a significant complication after MUS placement. Many patients continue to have incontinence despite the use of physical therapy/salvage sling placement. Furthermore, subjective outcomes and quality of life do not seem to improve over time. Because of the rarity of urethral perforation, our small series is notable given the absence of reported data that include prospective, long-term follow-up with validated questionnaire evaluation.
Insights
Repair of urethral perforation after midurethral sling (MUS) placement shows poor long-term outcomes. Many patients experience persistent incontinence and no significant improvement in quality of life despite further treatment.
Area of Science:
- Urology
- Female Pelvic Medicine and Reconstructive Surgery
Background:
- Urethral perforation is a rare but significant complication following midurethral sling (MUS) placement.
- Long-term outcomes after surgical repair of MUS-induced urethral perforation are not well-documented.
Purpose of the Study:
- To prospectively evaluate the long-term outcomes of patients undergoing surgical repair for urethral perforation secondary to MUS placement.
Main Methods:
- Five patients with International Continence Society-International Urogynecological Association grade 4B urethral injury post-MUS underwent transvaginal sling excision and urethral repair.
- Long-term follow-up (mean 54 months) included validated questionnaires for urinary, vaginal, and quality of life symptoms.
Main Results:
- Four of five patients experienced persistent stress urinary incontinence post-repair.
- Subjective outcomes, including urinary and vaginal symptoms and quality of life, showed no statistically significant improvement over long-term follow-up.
- Salvage treatments such as physical therapy and autologous fascial slings did not yield significant improvements.
Conclusions:
- Urethral perforation following MUS is associated with persistent incontinence and unimproved quality of life, even after surgical repair and salvage therapies.
- This study highlights the lack of effective long-term management strategies for this rare complication.
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