Salvage Surgery after Failed Treatment of Synthetic Mesh Sling Complications

Abstract

Purpose

The aim of this study is to report our experience with the diagnosis and treatment of refractory synthetic sling complications in women.

Materials/ Methods

This is a retrospective study of consecutive women with failed treatments for mesh sling complications. Pre- and postoperatively, patients completed validated questionnaires, voiding-diaries, uroflow with post-void residuals, pad-test, cystourethroscopy and videourodynamic studies. Treatment was individualized and results were subdivided into two groups – conditions and symptoms. Outcomes were assessed with the Patient Global Impression of Improvement (PGII) with success classified as a PGII of 1, improvement as 2-3, and fail as 4-7.

Results

Forty-seven women, aged 35-83 years (mean=60) had undergone at least 1 prior operation (range: 1-4) to correct sling complications. Original sling composition was Type-1 mesh in 36 patients and Types-2 and 3 in 11. Surgical procedures included sling incision, sling excision, urethrolysis, urethral reconstruction, ureteroneocystotomy, cystectomy & urinary diversion, and enterocystoplasty. Median follow-up was 2 years (range: 0.25 - 12, mean=3). Overall, a successful outcome was achieved in 34/47 (72%) after first salvage surgery. Reasons for failure were multiple for each patient. Of the 13 failures, 9 subsequently underwent 14 operations. Success/improvement was achieved in 5 women (56%) after continent urinary diversion (1), continent urinary diversion & cystectomy (1), partial cystectomy & augmentation cystoplasty (1), biologic sling (2) & sinus tract excision (1) and vaginal mesh excision (1).

Conclusions

Success after initial failure to repair mesh sling complications is possible, however, multiple surgeries may be required. Each symptom should be addressed separately.

http://www.jurology.com/article/S0022-5347(13)03691-4/abstract