Presentation and management of urethral erosion caused by mid-urethral sling

Mid-urethral slings (MUS) have been the standard of care in surgical management of female stress urinary incontinence (SUI) internationally. Complications including pain and erosion has led to a temporary "pause" of their use in the UK and Ireland. We report on our experience to date on patient presentation, operative management, and post-operative outcomes in management of MUS erosion.

Review of female patients who had partial MUS removal due to urethral erosion over a 7-year period. Data on patient presentation, operative technique, and post-operative outcomes were collected and collated.

A total of 21 patients were identified. Overall, 66% of patients presented with symptoms of urinary tract infection (UTI). Other presentations include overactive bladder symptoms (52%), recurrent incontinence (42%), or dyspareunia (9%). Some patients presented with a combination of these symptoms. Overall, 9 patients had a trans-obturator tape (TOT), 6 had a trans-vaginal tape (TVT), and 4 had unspecified type of MUS. Two patients had 2 previous MUS insertions. Initial operative management with urethroscopy and laser fragmentation in cases with significant MUS calcification was required in 18% (n = 4) of patients. A total of 86% (n = 18) of patients had urethral erosion that required formal urethral repair and a short period with an indwelling catheter. All patients had resolution of their UTI symptoms post procedure. Fifteen patients required further surgical intervention to manage recurrent incontinence after MUS removal.

Partial removal of MUS due to urethral erosion improves patient symptoms. However, the majority have recurrence of SUI and require further intervention.