Management of the complications of pubovaginal sling surgery

Abstract

Objective. To present complications of pubovaginal sling surgery (PVS) and their managements. Methods. A total of 21 patients who underwent PVS in 4 different tertiary refferal centers between June 2014 and May 2016 were reviewed retrospectively. Demographic characteristics of the patients, previous 6 history, daily pad use, Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ) were recorded. Also, the management of the complications were stated. Results. The mean age of the patients were 54.9±12.32 (range, 36-76) years. Six (28.5%) patients had a history of previous incontinence surgery and 15 (71.4%) patients were naïve. There were no intraoperative complications. The mean daily pad use was decreased from 4.04±0.95 to 0.95±0.86 (p=0.0001). While mean preoperative UDI-6 scores were decreased from 6.66±2.09 to 2.09±1.22 (p=0.0001) at postoperative sixth month; preoperative mean IIQ-7 scores decreased from 16.8±1.16 to 5.09±4.21 (p=0.0001) at postoperative sixth month. One (4.76%) patient had abdominal hernia at postoperative 2^nd year, three (14.28%) patients had an increased post-micturational residual (150-200ml) and two (9.52%) patients had urinary retention. Conclusion. Although the efficiency of PVS is high; one should aware of complications. The successful management of the complications will increase efficiency and patient satisfaction.

Keywords

• rectus fascia,Complication,pubovaginal sling,stress urinary incontinence

References

1. [1] Anger JT, Weinberg AE, Albo ME, Smith AL, Kim JH, Rodriguez LV, et al. Trends in surgical management of stress urinary incontinence among female Medicare beneficiaries. Urology 2009;74:283-7.
2. [2] Rac G, Younger A, Clemens JQ, Kobashi K, Khan A, Nitti V, et al. Stress urinary incontinence surgery trends in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the food and drug administration public health notifications. Neurourol Urodyn 2017;36:1155-60.
3. [3] Mitsui T, Tanaka H, Moriya K, Kakizaki H, Nonomura K. Clinical and urodynamic outcomes of pubovaginal sling procedure with autologous rectus fascia for stress urinary incontinence. Int J Urol 2007;14:1076-9.
4. [4] Bang SL, Belal M. Autologous pubovaginal slings: back to the future or a lost art? Res Rep Urol 2016;8:11-20.
5. [5] Bayrak O, Osborn D, Reynolds WS, Dmochowski RR. Pubovaginal sling materials and their outcomes. Turk J Urol 2014;40:233-9.
6. [6] Cross CA, Cespedes RD, English SF, McGuire EJ. Transvaginal urethrolysis for urethral obstruction after anti-incontinence surgery. J Urol 1998;159:1199-201.
7. [7] Sarver R, Govier FE. Pubovaginal slings: past, present and future. Int Urogynecol J Pelvic Floor Dysfunct 1997;8:358-68.
8. [8] 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;356:2143-55.

9. [9] Hou JC, Lemack GE. The role of fascial slings in the treatment of stress urinary incontinence in women: a 2013 update. Curr Urol Rep 2013;14:247-52.
10. [10] Chaikin DC, Rosenthal J, Blaivas JG. Pubovaginal fascial sling for all types of stress urinary incontinence: long-term analysis. J Urol 1998;160:1312-6.
11. [11] Cross CA, Cespedes RD, McGuire EJ. Our experience with pubovaginal slings in patients with stress urinary incontinence. J Urol 1998;159:1195-8.
12. [12] Athanasopoulos A, Gyftopoulos K, McGuire EJ. Efficacy and preoperative prognostic factors of autologous fascia rectus sling for treatment of female stress urinary incontinence. Urology 2011;78:1034-8.
13. [13] Blaivas JG, Chaikin DC. Pubovaginal fascial sling for the treatment of all types of stress urinary incontinence: surgical technique and long-term outcome. Urol Clin North Am 2011;38:7-15.
14. [14] Morgan TO, Jr., Westney OL, McGuire EJ. Pubovaginal sling: 4-year outcome analysis and quality of life assessment. J Urol 2000;163:1845-8.
15. [15] South MM, Wu JM, Webster GD, Weidner AC, Roelands JJ, Amundsen CL. Early vs late midline sling lysis results in greater improvement in lower urinary tract symptoms. Am J Obstet Gynecol 2009;200:564.e1-5.