Are complications of stress urinary incontinence surgery procedures associated with the position of the sling?

To evaluate whether the sling position is associated with particular types of complications in patients undergoing suburethral sling placement for stress urinary incontinence.

Data from 100 women diagnosed at the Evangelical Hospital Hagen-Haspe with complications after suburethral sling insertion were analyzed. All patients underwent pelvic floor ultrasound to assess: urethral length, sling location in relation to the urethral length (%) and the sling distance to the longitudinal smooth muscle complex of the urethra (the sling-longitudinal smooth muscle distance).

The shortest median sling-longitudinal smooth muscle distance was observed in patients with recurrent urinary tract infections, urinary retention and overactive bladder: 0.9, 1.1 and 1.75 mm, respectively (P < 0.05). In women with persistent stress urinary incontinence and sling erosion, the sling-longitudinal smooth muscle distance was 3.6 and 4.6 mm, respectively (P < 0.05). Persistent stress urinary incontinence was connected with the position of the sling in relation to the bladder neck - in these patients, the sling was closer to the bladder neck.

Sling location plays a pivotal role in the occurrence of certain complications. The sling position in the proximal part of the urethra or between the middle and proximal urethra appears to be connected with a high rate of unsuccessful stress urinary incontinence treatment. A sling-longitudinal smooth muscle distance below 2 mm is often connected with sling complications, such as overactive bladder, urinary retention and recurrent urinary tract infections.

International journal of urology : official journal of the Japanese Urological Association. 2016 Jan 01 [Epub ahead of print]

Jacek Kociszewski, George Fabian, Susanne Grothey, Andrzej Kuszka, Aneta Zwierzchowska, Wojciech Majkusiak, Ewa Barcz

Department of Gynecology and Obstetrics, Evangelical Hospital Hagen-Haspe, Hagen, Germany., 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland.