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Updated: Aug 6, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Outcomes of Total Excision of Retropubic and Transobturator Full Length Mid-Urethral Slings Using Standardised
Krishanthy Thayalan1,2,3,4, Hannah Krause5,6,7, Yu Hwee Tan5,6,7
1Gold Coast Health, Queensland Health, Brisbane, QLD, Australia. Krishanthy.thayalan@gmail.com.
Introduction And Hypothesis:
Mid-urethral slings (MUS) effectively treat stress urinary incontinence (SUI), although mesh-related complications occur in up to 3% of cases. These include mesh exposure, extrusion, perforation and associated pain; however, additional functional complications associated with sling placement include recurrent SUI, voiding dysfunction, recurrent cystitis symptoms and urge urinary incontinence. While some complications can be managed conservatively, others necessitate surgical excision. Management follows the AUGS-IUGA Joint Statement, although existing literature is limited by heterogenous surgical techniques. We aim to evaluate clinical and patient-reported outcomes following total MUS excision using a standard technique for patients with mesh-related complications.
Methods:
This retrospective case series included women undergoing total MUS excision between 2018 and 2024 at two tertiary mesh referral centres. Primary outcomes were symptom resolution and patient satisfaction assessed by Patient Global Impression of Improvement (PGI-I). Secondary outcomes included perioperative complications and postoperative recurrent SUI, including subgroup analysis of concomitant SUI surgery.
Results:
A total of 181 patients underwent planned total MUS excision (34.8% retropubic; 65.2% trans-obturator). Complete excision was successful in 99.4%. At median follow-up of 12 months (interquartile range 5-24 months), 91.7% reported resolution of their primary symptoms and 96.1% reported high satisfaction. Significant reductions were observed in pain (92.8% to 19.1%), urge urinary incontinence (65.7% to 44.2%) and recurrent cystitis symptoms (30.4% to 7.2%). Postoperative SUI requiring treatment occurred in 35.2%, lower than preoperative SUI rates (54.1%, p = 0.001). Concomitant SUI surgery reduced postoperative SUI (15.8% vs 37.5%, p < 0.005). No genitourinary fistula or wound breakdown occurred.
Conclusions:
Total MUS excision provides high symptom resolution and satisfaction with low complication rates. Post-excision SUI remains common but may be reduced with concomitant surgery in women with proven preoperative urodynamic SUI.
