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A Retrospective Multicenter Study on Outcomes After Midurethral Polypropylene Sling Revision for Voiding Dysfunction

Molden, Stephanie MD; Bracken, Jessica MD; Nguyen, Aimee MD; Harvie, Heidi S. MD; White, Amanda MD; Hammil, Sarah L. MD; Patterson, Danielle MD; Tarr, Megan MD; Sanses, Tatiana MD; Murphy, Miles MD, MSPH; Rogers, Rebecca G. MD

Female Pelvic Medicine & Reconstructive Surgery: November-December 2010 - Volume 16 - Issue 6 - p 340-344
doi: 10.1097/SPV.0b013e3181f5ac07
Original Articles
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Objectives: The purpose of this study was to determine outcomes of sling revision after midurethral sling (MUS) placement and whether timing of sling revision affected those outcomes.

Materials and Methods: This is a multicenter study including patients who underwent MUS placement and subsequent sling revision secondary to voiding dysfunction. Diagnostic outcomes before and after sling revision were compared for all sling revision patients with complete data. Logistic regression analyses were performed to determine if revision timing predicted voiding dysfunction and stress incontinence.

Results: One hundred seventy-five patients who met the study criteria had complete data. Overall, 70% (133) of MUS were retropubic and 30% (56) were obturator slings. Midurethral sling revision was accomplished by cutting (54%), excision (29%), and pulling down on the mesh (18%). Stress urinary incontinence (SUI) resolved in 38%, urinary tract infections (UTIs) in 69%, and overactive bladder (OAB) in 75%. In comparison, 21% experienced de novo SUI; 18%, de novo UTIs; and 12%, de novo OAB symptoms after revision. Voiding dysfunction resolved in 80%, however 10% experienced new voiding dysfunction symptoms. Retropubic slings displayed more voiding dysfunction, higher de novo/worsened OAB, and more UTIs after revision than obturator slings. Sling revision timing did not predict persistent voiding dysfunction but did predict SUI with earlier revision (≤2 weeks) resulting in less postrevision SUI when compared to revisions at 15-90 days or greater than 90 days. The method of sling revision (cut, excised, pulled down) did not predict SUI, OAB, or obstructive voiding symptoms.

Conclusions: Sling revision resolves voiding dysfunction symptoms, UTIs and post-sling OAB symptoms in the majority of patients. Resolution of voiding dysfunction is independent of method and timing of revision; however earlier revision is associated with decreased postrevision SUI.

Sling revision resolves voiding symptoms in the majority of patients; however, earlier revision is associated with less recurrent SUI and earlier resolution of symptoms independent of method of revision.

From the *Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, PA; †Scott & White, Temple, TX; ‡Evanston Northshore Hospital, Evanston, IL; §University of Pennsylvania, Philadelphia, PA; ∥University of Texas Southwestern Medical Center, Dallas, TX; ¶University of New Mexico, Albuquerque, NM; #Brigham and Women's Hospital, Boston, MA; **Loyola University, Chicago, IL; and ††Greater Baltimore Medical Center, Baltimore, MD.

Reprints: Stephanie Molden, MD, The Female Pelvic Health Center, 760, Newton Yardley Rd, Suite 115, Langhorne, PA 19047. E-mail: smolden@fphcenter.com.

Accepted for oral presentation at the 2010 annual scientific meeting of the Society of Gynecologic Surgeons in Tucson, AZ, April 12-14, 2010.

Financial support for this project was provided by the Society of Gynecologic Surgeons Fellows' Pelvic Research Network.

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