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Reporting and grading of complications after mid-urethral sling surgeries: Could the "Clavien-Dindo Classification"

Ahmed S El-Hefnawy1, Bassem S Wadie1

  • 1Urogynecology and Voiding Dysfunction Section, Urology Department, Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

Current Urology
|June 25, 2021
PubMed
Abstract

Insights

A modified Clavien-Dindo classification effectively grades mid-urethral sling complications. Most complications were minor (Grades I-II), but transvaginal tape (TVT) posed risks of serious, life-threatening events.

Area of Science:

  • Urology
  • Gynecology
  • Surgical Complications

Background:

  • Mid-urethral sling (MUS) procedures are common for stress urinary incontinence.
  • Standardized reporting of postoperative complications is crucial for patient safety and procedural improvement.
  • The Clavien-Dindo classification provides a framework for grading surgical complications.

Purpose of the Study:

  • To develop a modified Clavien-Dindo classification model for reporting MUS complications.
  • To compare the complication profiles of three distinct MUS procedures: transvaginal tape (TVT), transobturator tape (TOT), and autologous fascial sling.
  • To assess the incidence and severity of complications associated with each MUS type.

Main Methods:

  • A comprehensive PubMed search identified studies on MUS postoperative complications (1990-2018).
  • Reported complications were categorized using a modified Clavien-Dindo grading system.
  • The model was applied to data from 160 female patients undergoing TVT, TOT, or autologous fascial sling procedures with at least 24 months follow-up.

Main Results:

  • The mean patient age was 46 ± 7 years.
  • A total of 62 complications occurred in 43 (26.8%) patients.
  • Most complications were Grade I (12%) or Grade II (13%).
  • Fascial sling: highest rates of transient voiding difficulty and de novo urgency (15.4% each).
  • TOT: most frequent complication was transient thigh pain (10%).
  • TVT: associated with a serious, life-threatening vascular injury (Grade IV-a).

Conclusions:

  • The Clavien-Dindo classification is applicable for grading MUS postoperative complications.
  • The majority of MUS complications are minor (Grades I-II).
  • Transvaginal tape (TVT) procedures carry a risk of severe, life-threatening complications.
Keywords:
ComplicationsFascial slingMid-urethral slingStress urinary incontinenceTransobturator tapeTransvaginal tape

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