To evaluate pain improvement and recurrent stress incontinence (SUI) following painful synthetic midurethral sling (MUS) removal.
We conducted a retrospective review of patients who underwent synthetic MUS removal at our institution from 2009-2016 for the indication of pain. We recorded sling type (transobturator vs. retropubic), complete vs. partial removal, and presenting symptoms. Postoperative pain improvement was categorized as resolved (pain resolved, requiring no further therapy), improved (pain less bothersome, may require further therapy), or unresolved (no/minimal improvement, requiring further management). Recurrent incontinence and further reconstructive procedures were assessed.
87 patients (49 complete and 38 partial removal) with pain as the primary indication for removal were included. Median age at intervention was 54 years with median follow-up of 8 months. Overall, pain improved or resolved in 78.1% of cases. Complete removal was associated with significantly greater percentage of pain resolution (63.3%) compared to partial removal (26.3%) (p=0.002) regardless of sling type. No significant differences in recurrent SUI were noted in complete vs partial removal. Additional reconstructive procedures were performed in 28 patients, most commonly sling placement, with no significant difference in complete (20.4%) vs. partial (28.9%) removal groups (p=0.36). The overall complication rate was low (5.7%), a majority of which were transfusions (4.6%).
Following MUS removal, most patients experienced resolution or improvement of pain. Complete sling removal was associated with significantly greater percentage of pain resolution compared to partial removal in both retropubic and transobturator slings. Rates of recurrent SUI and reintervention for SUI were not related to the extent of sling removal.
Urology. 2021 Aug 30 [Epub ahead of print]
Jiping Zeng, Andrew Bergersen, Elinora Price, Michael Callegari, Evan Austin, Odutoyosi Oduyemi, Kristi Poling, Chiu-Hsieh Hsu, Joel Funk, Christian Twiss
Department of Urology, University of Arizona College of Medicine, Tucson, Arizona., Department of Urology, UH Cleveland Medical Center, Cleveland, Ohio., Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona., Department of Urology, University of Arizona College of Medicine, Tucson, Arizona. Electronic address: .