Cecile A Unger1, Anthony E Rizzo2, Beri Ridgeway2. 1. Obstetrics, Gynecology and Women's Health Institute, Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, 9500 Euclid Avenue/A81, Cleveland, OH, 44195, USA. ungerc@ccf.org. 2. Obstetrics, Gynecology and Women's Health Institute, Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, 9500 Euclid Avenue/A81, Cleveland, OH, 44195, USA.
Abstract
INTRODUCTION AND HYPOTHESIS: To determine the indications and risk factors for needing midurethral sling revision in a cohort of women undergoing midurethral sling placement. METHODS: This was a case-control study of all women undergoing midurethral sling placement for stress urinary incontinence (SUI) between January 2003 and December 2013. Cases were patients who underwent midurethral sling placement followed by sling revision (incision, partial or complete excision). Controls were patients who underwent sling placement only. Once all subjects had been identified, the electronic medical record was queried for demographic and perioperative and postoperative data. RESULTS: Of 3,307 women who underwent sling placement, 89 (2.7%, 95% CI 1.9 - 3.4) underwent sling revision for one or more of the following indications: urinary retention (43.8%), voiding dysfunction (42.7%), recurrent urinary tract infection (20.2%), mesh erosion (21.3%), vaginal pain/dyspareunia (7.9%), and groin pain (3.4%). The median time from the index to the revision surgery was 7.8 months (2.3 - 17.9 months), but was significantly shorter in patients with urinary retention. The type of sling placed (retropubic or transobturator) was not associated with indication for revision. Patients who underwent revision surgery were more likely to have had previous SUI surgery (adjusted odds ratio 4.4, 95% CI 1.7 - 6.5) and to have undergone concomitant vaginal apical suspension (adjusted odds ratio 2.4, 95% CI 1.4 - 4.5). CONCLUSIONS: The rate of sling revision after midurethral sling placement was 2.7%. Urinary retention and voiding dysfunction were the most common indications. Patients with a history of previous SUI surgery and concomitant apical suspension at the time of sling placement may be at higher risk of requiring revision surgery.
INTRODUCTION AND HYPOTHESIS: To determine the indications and risk factors for needing midurethral sling revision in a cohort of women undergoing midurethral sling placement. METHODS: This was a case-control study of all women undergoing midurethral sling placement for stress urinary incontinence (SUI) between January 2003 and December 2013. Cases were patients who underwent midurethral sling placement followed by sling revision (incision, partial or complete excision). Controls were patients who underwent sling placement only. Once all subjects had been identified, the electronic medical record was queried for demographic and perioperative and postoperative data. RESULTS: Of 3,307 women who underwent sling placement, 89 (2.7%, 95% CI 1.9 - 3.4) underwent sling revision for one or more of the following indications: urinary retention (43.8%), voiding dysfunction (42.7%), recurrent urinary tract infection (20.2%), mesh erosion (21.3%), vaginal pain/dyspareunia (7.9%), and groin pain (3.4%). The median time from the index to the revision surgery was 7.8 months (2.3 - 17.9 months), but was significantly shorter in patients with urinary retention. The type of sling placed (retropubic or transobturator) was not associated with indication for revision. Patients who underwent revision surgery were more likely to have had previous SUI surgery (adjusted odds ratio 4.4, 95% CI 1.7 - 6.5) and to have undergone concomitant vaginal apical suspension (adjusted odds ratio 2.4, 95% CI 1.4 - 4.5). CONCLUSIONS: The rate of sling revision after midurethral sling placement was 2.7%. Urinary retention and voiding dysfunction were the most common indications. Patients with a history of previous SUI surgery and concomitant apical suspension at the time of sling placement may be at higher risk of requiring revision surgery.
Authors: John N Nguyen; Sharon M Jakus-Waldman; Andrew J Walter; Terry White; Shawn A Menefee Journal: Obstet Gynecol Date: 2012-03 Impact factor: 7.661
Authors: Jennifer M Wu; Mihir P Gandhi; Aparna D Shah; Jatin Y Shah; Rebekah G Fulton; Alison C Weidner Journal: Int Urogynecol J Date: 2011-08-17 Impact factor: 2.894
Authors: Beri Ridgeway; Mark D Walters; Marie Fidela R Paraiso; Matthew D Barber; Sarah E McAchran; Howard B Goldman; J Eric Jelovsek Journal: Am J Obstet Gynecol Date: 2008-10-09 Impact factor: 8.661
Authors: Sara Abbott; Cecile A Unger; Janelle M Evans; Karl Jallad; Kevita Mishra; Mickey M Karram; Cheryl B Iglesia; Charles R Rardin; Matthew D Barber Journal: Am J Obstet Gynecol Date: 2013-10-11 Impact factor: 8.661
Authors: C A Unger; S Abbott; J M Evans; K Jallad; K Mishra; M M Karram; C B Iglesia; C R Rardin; M D Barber Journal: Int Urogynecol J Date: 2013-12-07 Impact factor: 2.894
Authors: Bernard T Haylen; Dirk de Ridder; Robert M Freeman; Steven E Swift; Bary Berghmans; Joseph Lee; Ash Monga; Eckhard Petri; Diaa E Rizk; Peter K Sand; Gabriel N Schaer Journal: Neurourol Urodyn Date: 2010 Impact factor: 2.696
Authors: Jill M Danford; David J Osborn; W Stuart Reynolds; Daniel H Biller; Roger R Dmochowski Journal: Int Urogynecol J Date: 2014-07-11 Impact factor: 2.894
Authors: Jacek Kociszewski; Wojciech Majkusiak; Andrzej Pomian; Paweł Tomasik; Edyta Horosz; Andrzej Kuszka; Ewa Barcz Journal: Biomed Res Int Date: 2016-11-23 Impact factor: 3.411
Authors: Bianca B Mengerink; Nassim Aourag; Kirsten B Kluivers; Kim J B Notten; John P F A Heesakkers; Frank M J Martens Journal: Cent European J Urol Date: 2021-11-18