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Recurrent Incontinence After Transvaginal Partial Sling Excision in Patients with Prior Mid-Urethral Sling.

Robert Shapiro1,2, Omar Felipe Dueñas-Garcia1, Manuel Vallejo1

  • 1Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, WV 26506, USA.

Research and Reports in Urology
|January 20, 2021
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Summary

Partial sling excision for complications after mid-urethral sling placement has a low risk of new urinary incontinence. Retropubic slings and higher preoperative flow rates may influence future incontinence surgery outcomes.

Keywords:
incontinencemeshmid-urethral singsling excision

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Area of Science:

  • Urology
  • Gynecology
  • Pelvic Floor Surgery

Background:

  • Complications from mid-urethral slings include recurrent UTIs, pain, dyspareunia, and voiding difficulty.
  • Partial sling excision is a treatment option for these post-sling complications.

Purpose of the Study:

  • Evaluate the incidence of de novo incontinence and voiding difficulty after partial sling excision.
  • Identify risk factors for future incontinence surgery in patients undergoing this procedure.

Main Methods:

  • Retrospective review of 95 female patients undergoing partial sling excision (2009-2017).
  • Assessed incontinence, voiding difficulty, and need for future incontinence surgery 6 months post-excision.
  • Statistical analysis included Pearson's Chi-square and t-tests.

Main Results:

  • 72% of patients achieved continence post-excision, regardless of initial symptoms.
  • No significant difference in voiding difficulty resolution between continent and incontinent patients.
  • Retropubic mid-urethral slings were associated with higher continence rates (p=0.03).
  • Preoperative maximum flow rate >16 mL/sec predicted future incontinence surgery (p=0.009).

Conclusions:

  • Partial sling excision has a low risk of causing new urinary incontinence.
  • Retropubic sling placement may reduce the likelihood of recurrent stress urinary incontinence.
  • Preoperative flow rate >16 mL/sec is a risk factor for subsequent incontinence surgery.