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Current Bladder Dysfunction Reports
Published in: Current Bladder Dysfunction Reports 4/2020

01-12-2020 | Stress Incontinence | Voiding Dysfunction Evaluation (B Brucker and B Peyronnet, Section Editors)

Urodynamics for the “Failed” Midurethral Sling

Authors: Christina Escobar, Benjamin Brucker

Published in: Current Bladder Dysfunction Reports | Issue 4/2020

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Abstract

Purpose of Review

The goal of this paper is to provide the reader with three distinct definitions of midurethral sling failure and provide guidance on the work up and management of each definition.

Recent Findings

The definition of sling failure should include not only patients with recurrent and persistent stress urinary incontinence but also those with de novo voiding symptoms and overactive bladder as a result of their midurethral sling. Urodynamics are less commonly performed for the straightforward patient with stress urinary incontinence prior to a midurethral sling. However, there is evidence that urodynamics studies can help with diagnosis and guide management in the patient with a failed midurethral sling.

Summary

When a patient experiences abnormalities of urinary storage or emptying after a midurethral sling, a comprehensive workup can help guide thoughtful and effective management of symptoms.
Literature
1.
Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.
2.
Luber KM. The definition, prevalence, and risk factors for stress urinary incontinence. Rev Urol. 2004;6(Suppl 3):S3–9.PubMedPubMedCentral
3.
Thom DJ. Variation in estimates of urinary incontinence prevalence in the community: effects of differences in definition, population characteristics, and study type. J Am Geriatr Soc. 1998;46(4):473–80.PubMed
4.
Rortveit G, Daltveit AK, Hannestad YS, SJNEJoM H. Urinary incontinence after vaginal delivery or cesarean section. Einstein (Sao Paulo). 2003;348(10):900–7.
5.
Hampel C, Wienhold D, Benken N, Eggersmann C, JJU T. Definition of overactive bladder and epidemiology of urinary incontinence. Urology. 1997;50(6):4–14.PubMed
6.
• Dumoulin C, Cacciari LP, EJC H-S. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10:Cd005654. This Cohrane review compares pelvic floor physical therapy for urinary incontinence to no treament or inactive controls.PubMed
7.
•• Bo K, Frawley HC, Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Int Urogynecol J. 2017;28(2):191–213. A consensus-based terminology report for the conservative management of female pelvic floor dysfunction.PubMed
8.
Oliphant SS, Jones KA, Wang L, Bunker CH, Lowder JL. Trends over time with commonly performed obstetric and gynecologic inpatient procedures. Obstet Gynecol. 2010;116(4):926–31.PubMedPubMedCentral
9.
Barber MD, Kleeman S, Karram MM, Paraiso MFR, Walters MD, Vasavada S, et al. Transobturator tape compared with tension-free vaginal tape for the treatment of stress urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2008;111(3):611–21.
10.
Richter HE, Albo ME, Zyczynski HM, Kenton K, Norton PA, Sirls LT, et al. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010;362(22):2066–76.
11.
Jonsson Funk M, Siddiqui NY, Kawasaki A, Wu JM. Long-term outcomes after stress urinary incontinence surgery. Obstet Gynecol. 2012;120(1):83–90.PubMed
12.
•• Gurol-Urganci I, Geary RS, Mamza JB, et al. Long-term rate of mesh sling removal following Midurethral mesh sling insertion among women with stress urinary incontinence. Jama. 2018;320(16):1659–69. Population-based retrospective cohort study investigating rate of long term mesh sling removal.PubMedPubMedCentral
13.
Gormley EA, Lightner DJ, Burgio KL, et al. Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline. J Urol. 2012;188(6S):2455–63.PubMed
14.
•• Guralnick ML, Fritel X, Tarcan T, Espuna-Pons M, Rosier PF. ICS Educational Module: Cough stress test in the evaluation of female urinary incontinence: Introducing the ICS-Uniform Cough Stress Test. Neurourol Urodyn. 2018;37(5):1849–55. Study describing standarized way to perform a cough stress tests.PubMed
15.
Harvey MA, Versi E. Predictive value of clinical evaluation of stress urinary incontinence: a summary of the published literature. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(1):31–7.PubMed
16.
•• Kobashi KC, Albo ME, Dmochowski RR, et al. Surgical treatment of female stress urinary incontinence: AUA/SUFU guideline. J Urol. 2017;198(4):875–83. Guideline and associated algorithm aimed to outline the currently available treatment techniques for the surgical management of stress urinary incontinence.PubMed
17.
Robinson BL, Geller EJ, Parnell BA, et al. Diagnostic accuracy of visual urethral mobility exam versus Q-Tip test: a randomized crossover trial. Am J Obstet Gynecol. 2012;206(6):528. e521–6.
18.
Miyazaki FS. The Bonney test: a reassessment. Am J Obstet Gynecol. 1997;177(6):1322–8.PubMed
19.
Giarenis I, Thiagamoorthy G, Zacche M, Robinson D, Cardozo L. Management of recurrent stress urinary incontinence after failed midurethral sling: a survey of members of the international Urogynecological association (IUGA). Int Urogynecol J. 2015;26(9):1285–91.PubMed
20.
Schafer W, Abrams P, Liao L, et al. Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn. 2002;21(3):261274.
21.
•• Abrams P, Andersson KE, Apostolidis A, et al. 6th International Consultation on Incontinence. Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence. Neurourol Urodyn. 2018;37(7):2271–2. Consensus statement and reccomendations for the diagnosis, evaluation and treatment of urinary incontinence, feacal incontinence, pelvic organ prolapse and pelvic pain syndrome.PubMed
22.
Al-Ghazo MA, Ghalayini IF, Al-Azab R, Hani OB, Matani YS, Haddad Y. Urodynamic detrusor overactivity in patients with overactive bladder symptoms. Int Neurourol J. 2011;15(1):48–54.PubMedPubMedCentral
23.
Hashim H, Abrams P. Is the bladder a reliable witness for predicting detrusor overactivity? J Urol. 2006;175(1):191–4.PubMed
24.
Lane TM, Shah PJ. Leak-point pressures. BJU Int. 2000;86(8):942–9.PubMed
25.
Turker P, Kilic G, Tarcan T. The presence of transurethral cystometry catheter and type of stress test affect the measurement of abdominal leak point pressure (ALPP) in women with stress urinary incontinence (SUI). Neurourol Urodyn. 2010;29(4):536–9.PubMed
26.
Maniam P, Goldman HB. Removal of transurethral catheter during urodynamics may unmask stress urinary incontinence. J Urol. 2002;167(5):2080–2.PubMed
27.
McGuire EJ, Fitzpatrick CC, Wan J, et al. Clinical assessment of urethral sphincter function. J Urol. 1993;150(5 Pt 1):1452–4.PubMed
28.
Sand PK, Bowen LW, Panganiban R, Ostergard DR. The low pressure urethra as a factor in failed retropubic urethropexy. Obstet Gynecol. 1987;69(3 Pt 1):399–402.PubMed
29.
Koonings PP, Bergman A, Ballard CA. Low urethral pressure and stress urinary incontinence in women: risk factor for failed retropubic surgical procedure. Urology. 1990;36(3):245–8.PubMed
30.
Nager CW, Schulz JA, Stanton SL, Monga A. Correlation of urethral closure pressure, leak-point pressure and incontinence severity measures. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(6):395–400.PubMed
31.
Nager CW, FitzGerald M. Kraus SR, et al, Urodynamic measures do not predict stress continence outcomes after surgery for stress urinary incontinence in selected women. J. Urol. 2008;179(4):1470–4.
32.
Lippmann QK, Diwadkar GB, Zhou H, Menefee SA. Trends in urodynamics study utilization in a Southern California managed care population. Am J Obstet Gynecol. 2015;213(5):724.e721–6.
33.
Nager CW, Sirls L, Litman HJ, Richter H, Nygaard I, Chai T, et al. Baseline urodynamic predictors of treatment failure 1 year after mid urethral sling surgery. J Urol. 2011;186(2):597–603.
34.
Stav K, Dwyer PL, Rosamilia A, Schierlitz L, Lim YN, Chao F, et al. Repeat synthetic mid urethral sling procedure for women with recurrent stress urinary incontinence. J Urol. 2010;183(1):241–6.
35.
Paick JS, Ku JH, Shin JW, Son H, Oh SJ, Kim SW. Tension-free vaginal tape procedure for urinary incontinence with low Valsalva leak point pressure. J Urol. 2004;172(4 Pt 1):1370–3.PubMed
36.
•• Bakali E, Johnson E, Buckley BS, Hilton P, Walker B, Tincello DG. Interventions for treating recurrent stress urinary incontinence after failed minimally invasive synthetic midurethral tape surgery in women. The Cochrane Database Syst Rev. 2019;9:Cd009407. A Cochrane review aimed to assess the effects of interventions for treating recurrent stress urinary incontinence after failed minimally invasive synthetic midurethral tape surgery in women.PubMed
37.
Hashim H, Terry TR. Management of recurrent stress urinary incontinence and urinary retention following midurethral sling insertion in women. Ann R Coll Surg Engl. 2012;94(7):517–22.PubMedPubMedCentral
38.
Zimmern PE, Gormley EA, Stoddard AM, Lukacz ES, Sirls L, Brubaker L, et al. Management of recurrent stress urinary incontinence after burch and sling procedures. Neurourol Urodyn. 2016;35(3):344–8.
39.
•• Gomelsky A, Athanasiou S, Choo MS, et al. Surgery for urinary incontinence in women: Report from the 6th international consultation on incontinence. Neurourol Urodyn. 2019;38(2):825–37. Summary of the findings and conclusions from the 6th International Consultation on Incontinence (ICI) regarding surgical treatment of urinary incontinence in women.PubMed
40.
Dmochowski RR, Blaivas JM, Gormley EA, et al. Update of AUA guideline on the surgical management of female stress urinary incontinence. J Urol. 2010;183(5):1906–14.PubMed
41.
Schierlitz L, Dwyer PL, Rosamilia A, Murray C, Thomas E, de Souza A, et al. Effectiveness of tension-free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency: a randomized controlled trial. Obstet Gynecol. 2008;112(6):1253–61.
42.
Schierlitz L, Dwyer PL, Rosamilia A, Murray C, Thomas E, de Souza A, et al. Three-year follow-up of tension-free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency. Obstet Gynecol. 2012;119(2 Pt 1):321–7.
43.
Houwert RM, Venema PL, Aquarius AE, Bruinse HW, Roovers JP, Vervest HA. Risk factors for failure of retropubic and transobturator midurethral slings. Am J Obstet Gynecol. 2009;201(2):202.e201–8.
44.
• Errando-Smet C, Ruiz CG, Bertran PA, Mavrich HV. A re-adjustable sling for female recurrent stress incontinence and intrinsic sphincteric deficiency: long-term results in 205 patients using the Remeex sling system. Neurourol Urodyn. 2018;37(4):1349–55. Describes long term outcomes and complications in patients who received the Remeex readjustable sling.PubMed
45.
• Maheshwari D, Jones K, Solomon E, Harmanli O. Sling plication for failed Midurethral sling procedures: a case series. Female pelvic medicine & reconstructive surgery. 2019;25(1):e4–6. Case series reporting outcomes of sling plications.
46.
Patterson D, Rajan S, Kohli N. Sling plication for recurrent stress urinary incontinence. Female Pelvic Med Reconstr Surg. 2010;16(5):307–9.PubMed
47.
Jeon MJ, Jung HJ, Chung SM, Kim SK, Bai SW. Comparison of the treatment outcome of pubovaginal sling, tension-free vaginal tape, and transobturator tape for stress urinary incontinence with intrinsic sphincter deficiency. Am J Obstet Gynecol. 2008;199(1):76.e71–4.
48.
Sanses TV, Brubaker L, Xu Y, Kraus SR, Lowder JL, Lemack GE, et al. Preoperative hesitating urinary stream is associated with postoperative voiding dysfunction and surgical failure following Burch colposuspension or pubovaginal rectus fascial sling surgery. Int Urogynecol J. 2011;22(6):713–9.
49.
Albo ME, Richter HE, Brubaker L, Norton P, Kraus SR, Zimmern PE, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med. 2007;356(21):2143–55.
50.
Dmochowski RR, Appell RA. Injectable agents in the treatment of stress urinary incontinence in women: where are we now? Urology. 2000;56(6):32–40.PubMed
51.
Corcos J, Fournier C. Periurethral collagen injection for the treatment of female stress urinary incontinence: 4-year follow-up results. Urology. 1999;54(5):815–8.PubMed
52.
Cross CA, English SF, Cespedes RD, EJJTJou MG. A followup on transurethral collagen injection therapy for urinary incontinence. J Urol. 1998;159(1):106–8.PubMed
53.
Norton PA, Nager CW. Chai TC, et al. Risk factors for incomplete bladder emptying after midurethral sling, Urology. 2013;82(5):1038–43.
54.
Blaivas JG, Purohit RS, Benedon MS, et al. Safety considerations for synthetic sling surgery. Nat Rev Urol. 2015;12(9):481.PubMed
55.
Appell R, Dmochowski RR, Blaivas J, Gormley E, Karram M, Juma S, et al. American urological association guidelines for the surgical management of stress incontinence: American Urological Association. Education and Research. 2009.
56.
Dietz HP, BTJIUJ H. Symptoms of voiding dysfunction: what do they really mean? Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(1):52–5.PubMed
57.
Sweeney DD, Leng WW. Treatment of postoperative voiding dysfunction following incontinence surgery. Current urology reports. 2005;6(5):365–70.PubMed
58.
Aponte MM, Shah SR, Hickling D, Brucker BM, Rosenblum N, Nitti VW. Urodynamics for clinically suspected obstruction after anti-incontinence surgery in women. J Urol. 2013;190(2):598–602.PubMed
59.
Ostergard DR. Ostergard's urogynecology and pelvic floor dysfunction: Lippincott Williams & Wilkins; 2008.
60.
Defreitas GA, Zimmern PE, Lemack GE, SFJU S. Refining diagnosis of anatomic female bladder outlet obstruction: comparison of pressure-flow study parameters in clinically obstructed women with those of normal controls. Urology. 2004;64(4):675–9.PubMed
61.
Brucker BM, Shah S, Mitchell S, Fong E, Nitti MD, Kelly CE, et al. Comparison of urodynamic findings in women with anatomical versus functional bladder outlet obstruction. Female Pelvic Med Reconstr Surg. 2013;19(1):46–50.
62.
Blaivas JG, Groutz A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn. 2000;19(5):553–64.PubMed
63.
Nitti VW, Tu LM, Gitlin J. Diagnosing bladder outlet obstruction in women. J Urol. 1999;161(5):1535–40.PubMed
64.
Gammie A, Kirschner-Hermanns R, Rademakers K. Evaluation of obstructed voiding in the female: how close are we to a definition? 2015;25(4, 295):292.
65.
Chassagne S, Bernier PA, Haab F, Roehrborn CG, Reisch JS, Zimmern PE. Proposed cutoff values to define bladder outlet obstruction in women. Urology. 1998;51(3):408–11.PubMed
66.
Lemack GE, Zimmern PE. Pressure flow analysis may aid in identifying women with outflow obstruction. J Urol. 2000;163(6):1823–8.PubMed
67.
Blaivas JG, Groutz AJN, Society UOJotIC. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn. 2000;19(5):553–64.PubMed
68.
• Solomon E, Yasmin H, Duffy M, et al. Developing and validating a new nomogram for diagnosing bladder outlet obstruction in women. Neurourol Urodyn. 2018;37(1):368–78. A study developing and validating a new nomogram for assessing bladder outlet obstruction in women.PubMed
69.
Akikwala TV, Fleischman N, Nitti VW. Comparison of diagnostic criteria for female bladder outlet obstruction. J Urol. 2006;176(5):2093–7.PubMed
70.
Massolt ET, Groen J, Vierhout ME. Application of the Blaivas-Groutz bladder outlet obstruction nomogram in women with urinary incontinence. Neurourol Urodyn. 2005;24(3):237–42.PubMed
71.
Wheeler TL 2nd, Richter HE, Greer WJ, Bowling CB, Redden DT, Varner RE. Predictors of success with postoperative voiding trials after a mid urethral sling procedure. J Urol. 2008;179(2):600–4.PubMed
72.
Cho ST, Song HC, Song HJ, Lee YG, Kim KK. Predictors of postoperative voiding dysfunction following Transobsturator sling procedures in patients with stress urinary incontinence. Int Neurourol J. 2010;14(1):26–33.PubMedPubMedCentral
73.
Hong B, Park S, Kim HS, Choo MS. Factors predictive of urinary retention after a tension-free vaginal tape procedure for female stress urinary incontinence. J Urol. 2003;170(3):852–6.PubMed
74.
Weinberger MW, Ostergard DR. Postoperative catheterization, urinary retention, and permanent voiding dysfunction after polytetrafluroethylene suburethral sling placement. Obstet Gynecol. 1996;87(1):50–4.PubMed
75.
Van den Broeck T, De Ridder D, Van der Aa F. The value of surgical release after obstructive anti-incontinence surgery: an aid for clinical decision making. Neurourol Urodyn. 2015;34(8):736–40.PubMed
76.
Leng WW, Davies BJ, Tarin T, Sweeney DD, Chancellor MB. Delayed treatment of bladder outlet obstruction after sling surgery: association with irreversible bladder dysfunction. J Urol. 2004;172(4 Pt 1):1379–81.PubMed
77.
Thomas AW, Cannon A, Bartlett E, Ellis-Jones J, Abrams P. The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow-up of untreated bladder outlet obstruction. BJU Int. 2005;96(9):1301–6.PubMed
78.
Nguyen JN. Tape mobilization for urinary retention after tension-free vaginal tape procedures. Urology. 2005;66(3):523–6.PubMed
79.
Moore CK, Goldman HB. Simple sling incision for the treatment of iatrogenic bladder outlet obstruction. Int Urogynecol J. 2013;24(12):2145–6.PubMed
80.
Foster HE, McGuire EJ. Management of urethral obstruction with transvaginal urethrolysis. J Urol. 1993;150(5 Pt 1):1448–51.PubMed
81.
Clifton MM, Linder BJ, Lightner DJ, Elliott DS. Risk of repeat anti-incontinence surgery following sling release: a review of 93 cases. J Urol. 2014;191(3):710–4.PubMed
82.
Thiel DD, Pettit PD, McClellan WT, Petrou SP. Long-term urinary continence rates after simple sling incision for relief of urinary retention following fascia lata pubovaginal slings. J Urol. 2005;174(5):1878–81.PubMed
83.
Sajadi KP, Vasavada SP. Overactive bladder after sling surgery. Current urology reports. 2010;11(6):366–71.PubMed
84.
Latthe PM, Foon R, Toozs-Hobson P. Transobturator and retropubic tape procedures in stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications. BJOG. 2007;114(5):522–31.PubMed
85.
Elbadawi A, Yalla SV, Resnick NM. Structural basis of geriatric voiding dysfunction. IV. Bladder outlet obstruction. J Urol. 1993;150(5 Pt 2):1681–95.PubMed
86.
• Peyronnet B, Mironska E, Chapple C, et al. A comprehensive review of overactive bladder pathophysiology: on the way to tailored treatment. Eur Urol. 2019;75(6):988–1000. A comprehensive analysis of the potential pathophysiology underlying detrusor overactivity (DO) and OAB.PubMed
87.
Murray S, Haverkorn RM, Koch YK, Lemack GE, Zimmern PE. Urethral distortion after placement of synthetic mid urethral sling. J Urol. 2011;185(4):1321–6.PubMed
88.
Kershen RT, Appell RA. De novo urge syndrome and detrusor instability after anti-incontinence surgery: current concepts, evaluation, and treatment. Curr Urol Rep. 2002;3(5):345–53.PubMed
89.
Escobar C, Peyronnet B, Sussman R, et al. MP56–05 Sling revision for bladder outlet obstruction in women with primarily storage symptoms: what are the best urodynamic criteria to predict outcomes? J Urol. 2019;201(Supplement 4):e805–5.
90.
Lee JK, Dwyer PL, Rosamilia A, Lim YN, Polyakov A, Stav K. Which women develop urgency or urgency urinary incontinence following midurethral slings? Int Urogynecol J. 2013;24(1):47–54.PubMed
91.
Powers K, Lazarou G, Greston WM. Delayed urethral erosion after tension-free vaginal tape. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(4):422–5.PubMed
Metadata
Title
Urodynamics for the “Failed” Midurethral Sling
Authors
Christina Escobar
Benjamin Brucker
Publication date
01-12-2020
Publisher
Springer US
Published in
Current Bladder Dysfunction Reports / Issue 4/2020
Print ISSN: 1931-7212
Electronic ISSN: 1931-7220
DOI
https://doi.org/10.1007/s11884-020-00589-x

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