Voiding Dysfunction Following Removal of Eroded Synthetic Mid Urethral Slings

Jonathan S. Starkman, Christopher Wolter, Alex Gomelsky, Harriette M. Scarpero, Roger R. Dmochowski

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Purpose: Voiding dysfunction following genitourinary erosion of synthetic mid urethral slings is not clearly reported. We investigated the incidence of voiding dysfunction in patients following sling excision due to vaginal, urethral or intravesical mesh erosion. Materials and Methods: Retrospective review identified 19 patients with genitourinary erosion of polypropylene mesh slings. Comprehensive urological evaluation was performed in all patients, and perioperative and postoperative data were analyzed. Voiding dysfunction was defined as refractory storage symptoms, emptying symptoms and pelvic pain. All subsequent medical and surgical interventions were recorded. Results: In 19 patients a total of 11 vaginal, 7 intravesical and 5 urethral erosions occurred. Mean patient age was 52 years (range 32 to 69) and average followup was 8.4 months (range 3 to 34). Average time from symptom onset to sling removal was 10.1 months (range 1.5 to 38). Of the 19 patients 14 (74%) presented with multiple symptoms. Symptoms varied, including refractory pain, recurrent infections and bladder storage/emptying dysfunction. Urodynamic studies were abnormal preoperatively and postoperatively in 9 of 13 (69%) and 4 of 6 patients (67%), respectively. Following surgery lower urinary tract symptoms resolved completely in only 4 of the 19 patients (21%). Stress incontinence recurred in 8 of the 19 patients (42%). Five patients underwent simultaneous pubovaginal sling, of whom none had recurrent stress urinary incontinence. Only 9 patients (47%) considered themselves dry with no pads following surgery. Four patients required further surgery for refractory voiding symptoms. Conclusions: Voiding dysfunction is not an uncommon finding after sling excision in the setting of genitourinary erosion. It may cause additional patient morbidity.

Original languageEnglish (US)
Pages (from-to)1040-1044
Number of pages5
JournalJournal of Urology
Volume176
Issue number3
DOIs
StatePublished - Sep 2006
Externally publishedYes

Fingerprint

Suburethral Slings
Intractable Pain
Lower Urinary Tract Symptoms
Stress Urinary Incontinence
Pelvic Pain
Polypropylenes
Urodynamics

Keywords

  • bladder
  • prostheses and implants
  • urethra
  • urinary incontinence
  • vagina

ASJC Scopus subject areas

  • Urology

Cite this

Starkman, J. S., Wolter, C., Gomelsky, A., Scarpero, H. M., & Dmochowski, R. R. (2006). Voiding Dysfunction Following Removal of Eroded Synthetic Mid Urethral Slings. Journal of Urology, 176(3), 1040-1044. https://doi.org/10.1016/j.juro.2006.04.103

Voiding Dysfunction Following Removal of Eroded Synthetic Mid Urethral Slings. / Starkman, Jonathan S.; Wolter, Christopher; Gomelsky, Alex; Scarpero, Harriette M.; Dmochowski, Roger R.

In: Journal of Urology, Vol. 176, No. 3, 09.2006, p. 1040-1044.

Research output: Contribution to journalArticle

Starkman, JS, Wolter, C, Gomelsky, A, Scarpero, HM & Dmochowski, RR 2006, 'Voiding Dysfunction Following Removal of Eroded Synthetic Mid Urethral Slings', Journal of Urology, vol. 176, no. 3, pp. 1040-1044. https://doi.org/10.1016/j.juro.2006.04.103
Starkman JS, Wolter C, Gomelsky A, Scarpero HM, Dmochowski RR. Voiding Dysfunction Following Removal of Eroded Synthetic Mid Urethral Slings. Journal of Urology. 2006 Sep;176(3):1040-1044. https://doi.org/10.1016/j.juro.2006.04.103
Starkman, Jonathan S. ; Wolter, Christopher ; Gomelsky, Alex ; Scarpero, Harriette M. ; Dmochowski, Roger R. / Voiding Dysfunction Following Removal of Eroded Synthetic Mid Urethral Slings. In: Journal of Urology. 2006 ; Vol. 176, No. 3. pp. 1040-1044.
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abstract = "Purpose: Voiding dysfunction following genitourinary erosion of synthetic mid urethral slings is not clearly reported. We investigated the incidence of voiding dysfunction in patients following sling excision due to vaginal, urethral or intravesical mesh erosion. Materials and Methods: Retrospective review identified 19 patients with genitourinary erosion of polypropylene mesh slings. Comprehensive urological evaluation was performed in all patients, and perioperative and postoperative data were analyzed. Voiding dysfunction was defined as refractory storage symptoms, emptying symptoms and pelvic pain. All subsequent medical and surgical interventions were recorded. Results: In 19 patients a total of 11 vaginal, 7 intravesical and 5 urethral erosions occurred. Mean patient age was 52 years (range 32 to 69) and average followup was 8.4 months (range 3 to 34). Average time from symptom onset to sling removal was 10.1 months (range 1.5 to 38). Of the 19 patients 14 (74{\%}) presented with multiple symptoms. Symptoms varied, including refractory pain, recurrent infections and bladder storage/emptying dysfunction. Urodynamic studies were abnormal preoperatively and postoperatively in 9 of 13 (69{\%}) and 4 of 6 patients (67{\%}), respectively. Following surgery lower urinary tract symptoms resolved completely in only 4 of the 19 patients (21{\%}). Stress incontinence recurred in 8 of the 19 patients (42{\%}). Five patients underwent simultaneous pubovaginal sling, of whom none had recurrent stress urinary incontinence. Only 9 patients (47{\%}) considered themselves dry with no pads following surgery. Four patients required further surgery for refractory voiding symptoms. Conclusions: Voiding dysfunction is not an uncommon finding after sling excision in the setting of genitourinary erosion. It may cause additional patient morbidity.",
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