Top

Published in:

06-04-2021 | Stress Incontinence | Original Article

Functional outcomes of vaginal surgery for urethral extrusion of mid-urethral tape in women

Authors: Bogdan Toia, Stephen Unterberg, Neha Sihra, Mahreen Pakzad, Rizwan Hamid, Jeremy L. Ockrim, Tamsin J. Greenwell

Published in: International Urogynecology Journal | Issue 8/2022

Abstract

Introduction and hypothesis

We aim to determine the presentation of and immediate and longer-term outcomes of vaginal surgical excision of urethral extrusion of mid-urethral tape (MUT).

Methods

We performed a retrospective analysis of all patients with urethral extrusion of MUT having vaginal surgical excision between 2007 and 2018. The MUT was removed either partially (via vaginal approach) or completely (via combined vaginal and laparoscopic approach). Functional outcomes and any re-interventions are described.

Results

Thirty-four patients of median age 53 (range 34–82) years were identified. Preoperative symptomatic recurrent/persistent urinary incontinence was present in 29/34(85%) with 24/34(71%) women having recurrent/persistent stress urinary incontinence (SUI) or stress predominant mixed urinary incontinence (s-MUI) on urodynamics. Vaginal surgical excision was performed alone in 33/34(97%) women and in combination with laparoscopic removal of abdominopelvic MUT in 1/34(3%) woman. In the longer term vaginal/urethral pain resolved or improved in all 15/15(100%) patients presenting with this complaint whilst patient reported poor flow resolved in 8/9 (89%) women. Twenty-eight of 34 women (82%) had persistent/recurrent SUI or s-MUI following MUT excision. Twenty-four of 34 women (71%) had further SUI surgery with cure or improvement of SUI in 20/24 (83%) patients.

Conclusions

The outcome of vaginal surgical excision of the MUT was cure or improvement of pain in 100% and resolution of poor flow in 89% women. Recurrent/persistent SUI or s-MUI was present in 82% following removal as compared to 71% women prior to removal. Of the 71% of women electing to have further surgery for recurrent/persistent SUI/s-MUI, 83% were dry or improved afterwards.

Cashman S, Biers S, Greenwell T, et al. Results of the British Association of Urological Surgeons female stress urinary incontinence procedures outcomes audit 2014-2017. BJU Int. 2019;123:149–59. https://doi.org/10.1111/bju.14541.CrossRefPubMed

Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2017. https://doi.org/10.1002/14651858.CD006375.pub4.

Richter HE, Albo ME, Zyczynski HM, et al. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010;362:2066–76. https://doi.org/10.1056/NEJMoa0912658.CrossRefPubMedPubMedCentral

Viereck V, Rautenberg O, Kociszewski J, et al. Midurethral sling incision: indications and outcomes. Int Urogynecol J Pelvic Floor Dysfunct. 2013;24:645–53. https://doi.org/10.1007/s00192-012-1895-8.CrossRef

Jonsson Funk M, Siddiqui NY, Pate V, et al. Sling revision/removal for mesh erosion and urinary retention: long-term risk and predictors. Am J Obstet Gynecol. 2013;208:73.e1–7. https://doi.org/10.1016/j.ajog.2012.10.006.CrossRef

Welk B, Al-Hothi H, Winick-Ng J. Removal or revision of vaginal mesh used for the treatment of stress urinary incontinence. JAMA Surg. 2015;150:1167–75. https://doi.org/10.1001/jamasurg.2015.2590.CrossRefPubMed

Baracat F, Mitre AI, Kanashiro H, Montellato NID. Endoscopic treatment of vesical and urethral perforations after tension-free vaginal tape (TVT) procedure for female stress urinary incontinence. Clinics (Sao Paulo). 2005;60:397–400. https://doi.org/10.1590/s1807-59322005000500008.CrossRef

Sergouniotis F, Jarlshammar B, Larsson P-G. Urethral complications after tension-free vaginal tape procedures: a surgical management case series. World J Nephrol. 2015;4:396–405. https://doi.org/10.5527/wjn.v4.i3.396.CrossRefPubMedPubMedCentral

Blaivas JG, Olsson CA. Stress incontinence: classification and surgical approach. J Urol. 1988;139:727–31. https://doi.org/10.1016/S0022-5347(17)42611-5.CrossRefPubMed

10.

Wilson A, Pillay S, Greenwell T. How and why to take a Martius labial interposition flap in female urology. Transl Androl Urol. 2017;6:S81–7.CrossRef

11.

Greenwell T, Cutner A. The anatomy and an illustrated description of a technique for combined laparoscopic and vaginal total removal of an obturator mid urethral tape. Transl Androl Urol. 2018;7:978–81. https://doi.org/10.21037/tau.2018.10.05.CrossRefPubMedPubMedCentral

12.

Kim JH, Doo SW, Yang WJ, Song YS. Laparoscopic transvesical excision and reconstruction in the management of mid-urethral tape mesh erosion and stones around the bladder neck: initial experiences. BJU Int. 2012;110:E1009–13. https://doi.org/10.1111/j.1464-410X.2012.11563.x.CrossRefPubMed

13.

Abrams P, Avery K, Gardener N, Donovan J. The international consultation on incontinence modular questionnaire: www.iciq.net. J Urol. 2006;175:1063–6. https://doi.org/10.1016/S0022-5347(05)00348-4.CrossRefPubMed

14.

Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg. 2012;255:922–8. https://doi.org/10.1097/SLA.0b013e31824f1c21.CrossRefPubMed

15.

Rogers RG, Coates KW, Kammerer-Doak D, et al. A short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12). Int Urogynecol J. 2003;14:164–8. https://doi.org/10.1007/s00192-003-1063-2.CrossRef

16.

Carlsson AM. Assessment of chronic pain. I Aspects of the reliability and validity of the visual analogue scale. Pain. 1983;16:87–101. https://doi.org/10.1016/0304-3959(83)90088-X.CrossRefPubMed

17.

Gomes CM, Carvalho FL, Bellucci CHS, et al. Update on complications of synthetic suburethral slings. Int. Braz J Urol. 2017;43:822–34.CrossRef

18.

Deng DY, Rutman M, Raz S, Rodriguez LV. Presentation and management of major complications of midurethral slings: are complications under-reported? Neurourol Urodyn. 2007;26:46–52. https://doi.org/10.1002/nau.20357.CrossRefPubMed

19.

Kuuva N, Nilsson CG. A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand. 2002;81:72–7. https://doi.org/10.1034/j.1600-0412.2002.810113.x.CrossRefPubMed

20.

Osborn DJ, Dmochowski RR, Harris CJ, et al. Analysis of patient and technical factors associated with midurethral sling mesh exposure and perforation. Int J Urol. 2014;21:1167–70. https://doi.org/10.1111/iju.12544.CrossRefPubMedPubMedCentral

21.

Chevrot A, Droupy S, Coffin G, et al. Long-term efficacy and safety of tension free vaginal tape in a historic cohort of 463 women with stress urinary incontinence. Int Urogynecol J. 2017;28:827–33. https://doi.org/10.1007/s00192-016-3230-2.CrossRefPubMed

22.

Lee D, Bacsu C, Dillon B, et al. Complications following the insertion of two synthetic mid-urethral slings and subsequent removal. LUTS Low Urin Tract Symptoms. 2018;10:259–65. https://doi.org/10.1111/luts.12175.CrossRefPubMed

23.

Malde S, Spilotros M, Wilson A, et al. The uses and outcomes of the Martius fat pad in female urology. World J Urol. 2017;35:473–8. https://doi.org/10.1007/s00345-016-1887-2.CrossRefPubMed

Title: Functional outcomes of vaginal surgery for urethral extrusion of mid-urethral tape in women
Authors: Bogdan Toia
Stephen Unterberg
Neha Sihra
Mahreen Pakzad
Rizwan Hamid
Jeremy L. Ockrim
Tamsin J. Greenwell
Publication date: 06-04-2021
Publisher: Springer International Publishing
Keywords: Stress Incontinence
Urinary Incontinence
Voiding Disorder
Urinary Incontinence
Published in: International Urogynecology Journal / Issue 8/2022
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-021-04774-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Functional outcomes of vaginal surgery for urethral extrusion of mid-urethral tape in women

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2022

A retrospective study of risk factors for stress urinary incontinence 1 year after delivery in multiparous women

Evaluating tissue-engineered repair material for pelvic floor dysfunction: a comparison of in vivo response to meshes implanted in rats

Commentary on “Predictors of postoperative complications from stress urinary incontinence procedures: a NSQIP database study”

Covert postpartum urinary retention: causes and consequences (PAREZ study)

A commentary on “Evaluation of the histological and biomechanical properties of poly-4-hydroxybutyrate (P4HB) scaffold for pelvic organ prolapse, as compared to polypropylene mesh in a rabbit model”

A new treatment of an intravesical eroded mesh after TVM: 3 mm trocar-assisted cystoscopic approach