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Midurethral sling infectious complications: A systematic review.
Ylan Camby1, Camille Gordeeff1, Claire Cardaillac1
1Department of Obstetrics, Gynecology and Reproductive Medicine, Nantes University Hospital, 38, boulevard Jean-Monnet, 44000 Nantes, France.
The French Journal of Urology
|August 9, 2024
Summary
Midurethral slings effectively treat stress urinary incontinence but can cause infections. Prophylactic measures like urinalysis and antibiotics, alongside early intervention with broad-spectrum antibiotics and prosthesis removal, are crucial for managing complications.
Area of Science:
- Urology
- Gynecology
- Infectious Diseases
Background:
- Midurethral slings are recommended for stress urinary incontinence.
- While effective, these slings pose risks of severe infectious complications.
- Current guidelines recommend slings, but infection risks require attention.
Purpose of the Study:
- To review infectious complications associated with midurethral slings.
- To analyze reported cases of infection following sling implantation.
- To evaluate management strategies for prosthetic and surgical site infections.
Main Methods:
- Comprehensive literature review of PubMed, Medline, Embase, and Cochrane databases.
- Keywords included "stress urinary incontinence," "complications," "infections," and specific sling types.
- Analysis of 61 articles detailing infectious complications from synthetic midurethral slings.
Main Results:
- Infections reported include abscesses (36), cellulitis (21), fistulas (16), and prosthetic exposures (41).
- Preoperative urinalysis and intraoperative antibiotic prophylaxis were infrequently documented.
- Broad-spectrum antibiotics were used in 95.5% of cases; 56% required total prosthesis explantation.
Conclusions:
- Preoperative urinalysis and intraoperative antibiotic prophylaxis should be considered to limit infection risks.
- Early initiation of broad-spectrum antibiotics is recommended for prosthetic or surgical site infections.
- Total explantation of the prosthesis appears to be the most effective surgical strategy for managing infections.
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