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Sling Plication for Failed Midurethral Sling Procedures

A Case Series

Maheshwari, Deepali, DO*; Jones, Keisha, MD*; Solomon, Ellen, MD*; Harmanli, Oz, MD

Female Pelvic Medicine & Reconstructive Surgery: January/February 2019 - Volume 25 - Issue 1 - p e4–e6
doi: 10.1097/SPV.0000000000000630
Case Series
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Objectives The aim of this article is to report the outcomes of sling plications performed on women who presented with persistent stress urinary incontinence after midurethral sling.

Methods All women who underwent sling plication for persistent stress urinary incontinence after placement of either retropubic or transobturator midurethral sling were included in this case series. For plication, first, the suburethral incision was opened. After mobilization of the mesh in the midline, the sling was plicated with absorbable sutures. Descriptive data were extracted from the electronic medical record. Postoperative stress urinary incontinence was diagnosed based on patients' response to the relevant question on the urinary distress inventory and compared this outcome with respect to the original sling placement approach.

Results We identified 36 women who underwent sling plication between March 2013 and November 2016: 26 (72.2%) following a retropubic and 10 (27.7%) following a transobturator sling. Median time between midurethral sling and plication procedure was 6.8 weeks (range, 2–148 weeks). Median follow-up after sling plication was 17 weeks (range, 2–104 weeks). Overall, 24 women (66.6%) reported subjective resolution of stress incontinence. Success rate for plication of retropubic slings was 20 (76.9%) of 26 and significantly higher compared with 4 (40%) of 10 for transobturator slings (P = 0.034). There were no mesh erosions or persistent urinary retention after sling plication.

Conclusions Sling shortening by plication is an effective low-risk option for the management of persistent stress urinary incontinence following a midurethral sling. This approach was found to be more successful after retropubic slings.

From the *Urogynecology and Pelvic Surgery, University of Massachusetts School of Medicine–Baystate, Springfield, MA; and

Yale Urogynecology and Pelvic Reconstructive Surgery, Yale School of Medicine, New Haven, CT.

Correspondence: Oz Harmanli, MD, Yale School of Medicine, 310 Cedar Street, FMB 329B, New Haven, CT 06510. E-mail: oz.harmanli@yale.edu.

The authors have declared they have no conflicts of interest.

This study was presented at the annual meeting of the American Urogynecology Society in Providence, Rhode Island, in 2017.

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